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PRINCIPLES  AND  PRACTICE 


OF 


SPINAL  ADJUSTMENT 


For  the  Use  of  Students 
and  Practitioners 


BY 

ARTHUR  L.  FORSTER,  M.D.,  DC. 


WITH  NINETY-XIXE  ILLUSTRATIONS 


CHICAGO 

THE  NATIONAL  SCHOOL  OF  CHIROPRACTIC 

421-427  SOUTH  ASHLAND  BOULEVARD 

1915 


Copyright,  1915. 
THE  NATIONAL  SCHOOL  OF  CHIROPRACTIC 


H 


DEDICATED  TO 

HtUtam  Olljarlffi  ^rI|ulHP,  MM, 

IN    ADMIRATION    OF    HIS    VALUABLE    WORK    IN 

PHYSIOLOGICAL    THERAPEUTICS    AND 

AS  A  TOKEN  OF  MY  SINCERE 

REGARD  AND  ESTEEM 


PREFACE 

This  book  has  been  written  primarily  with  a  view  to  pre- 
senting the  subject  of  Spinal  Adjustment  along  strictly  scien- 
tific lines.  While  the  theory  of  Spinal  Adjustment  has  been 
repeatedly  propounded,  and  its  value  as  a  remedial  agency 
undeniably  proved  by  the  clinical  results  of  those  who  have 
preceded  me  in  this  field  of  endeavor,  I  think  that  this  work 
will  constitute  a  step  forward  in  placing  this  subject  upon  a 
scientific  basis,  and  prove  for  all  time  that  it  rests  upon  facts 
that  are  irrefutable. 

In  common  w'ith  most  advances  in  the  art  of  healing.  Spinal 
Adjustment  was  first  used  in  a  purely  empirical  manner,  its 
own  advocates  being  unable  to  explain  satisfactorily  the  re- 
sults produced  through  its  use.  Careful  investigation,  how- 
ever, has  revealed  the  premises  and  furnished  the  data  which 
rescue  this  form  of  treatment  from  the  empiricism  of  the  past 
and  put  it  upon  a  substantial  basis. 

The  greatest  obstacle  to  the  general  adoption  of  Spinal 
Adjustment  has  been  the  inherited  belief  that  vertebral  sub- 
luxations are  impossible.  This  belief  has  been  successfully 
shattered  by  a  large  amount  of  experimental  work,  particularly 
upon  the  cadaver.  In  this  work  I  was  ably  assisted  by  Dr. 
Erik  Juhl  and  I  hereby  make  grateful  acknowledgement  of  this 
gentleman's  great  help  in  this  connection. 

The  first  section  of  this  work  deals  with  the  principles  of 
Chiropractic.  For  verification  of  the  different  physiological 
facts  enumerated  in  this  part  of  the  book  I  have  referred  quite 
extensively  to  the  American  Text  Book  of  Physiology  and 
Kirk's  Physiology. 

The  anatomy  and  physiology  of  the  nervous  system,  and 
the  spinal  nerve  influence  upon  the  various  organs,  are  an  es- 
sential feature  in  a  work  of  this  nature,  and  must  be  thor- 
oughly understood  in  order  to  appreciate  the  modus  operandi 
of  Spinal  Adjustment. 


Vlll 


PREFACE 


The  section  on  Vertebral  Mal-alignment  shows  the  direct 
causes  of  subluxation  of  the  vertebrae,  and  further  shows  the 
manner  in  which  they  may  be  produced  reflexly.  The  exact 
manner  of  such  reflex  production  of  Spinal  Lesions  is  of  vital 
importance  to  a  comprehension  of  the  fact  that  pre-existing 
subluxations  not  only  cause  disease  but  may  themselves  be 
produced  by  disease. 

The  section  on  Spinal  Analysis  presents  this  important  sub- 
ject in  a  manner  which  should  make  it  of  practical  value  to 
students  and  practitioners.  The  classification  of  the  various 
forms  of  vertebral  subluxations  is,  we  think,  logical  and 
therefore  easy  to  remember. 

In  the  section  giving  the  various  holds  used  in  the  adjust- 
ment of  subluxations,  those  which  have  been  found  after  long 
usage  to  be  the  most  practical  have  been  presented.  These 
holds  have  been  given  a  new  and  distinctive  nomenclature ; 
they  have  been  described  briefly  and  concisely,  and  they  are 
accompanied  by  original  illustrations,  which  have  been  pre- 
pared with  great  care.  While  these  holds  are  not  all  original 
and  have  become  common  property,  still  it  is  only  meet  that 
our  indebtedness  to  the  pathfinders  in  this  field  of.  work,  not- 
ably Dr.  John  F.  A.  Howard,  and  others,  should  be  expressed. 
Lack  of  space  forbids  detailed  reference  in  every  instance,  and 
this  inadequate  way  of  acknowledging  a  heavy  debt  must 
suffice. 

The  section  dealing  with  the  Practice  of  Spinal  Adjustment 
we  consider  a  valuable  feature  both  for  the  practitioner  and 
for  use  in  schools. 

I  am  under  deep  obligation  to  my  friend  and  colleague,  Dr. 
W.  C.  Schulze,  without  whose  encouragement  and  assistance 
the  publication  of  this  book  would  not  have  been  possible. 

My  thanks  are  also  due  Miss  Amy  Schultz  for  valuable 
assistance  in  the  preparation  of  the  manuscript  of  the  last 
section  of  the  book. 

The  illustrations  are  in  the  main  original,  and  at  a  sacrifice 
of  artistic  finesse  for  technical  accuracy  I  have  executed  them 
myself.     For  all  others  credit  has  been  given. 

A.  L.  F. 
Chicago,  May,  1915. 


TABLE  OF  CONTENTS 


SECTION  I 


PRINCIPLES  OF  CHIROPRACTIC 

CHAPTER  PAGF. 

I     The  Origin  of  Chiropractic 1-4 

II     The  Theoretical   Basis  of  Chiropractic 5-14 

III  The  Anatomical  Basis  of  Chiropractic 15-38 

IV  The  Physiological  Basis  of  Chiropractic 39-45 


SECTION  2 
THE  SYMPATHETIC  NERVOUS  SYSTEM 

I     The  Anatomy    of    the    Sympathetic    Nervous 

System 47-60 

II  The  Connection  Between  the  Sympathetic 
Nervous  System  and  the  Cerebro-Spinal 
Nervous  System 61-66 

III  The     Connection     Between     the     Sympathetic 

Nervous  System  and  the  Cranial  Nerves 67-74 

IV  The  Physiology  of  the  Nervous  System 75-^5 

— --V     The  Physiology  of  the  Nervous  System  (cont.)       86-92 

— VI     The  Physiology  of  the  Sympathetic  System...      93-1  ro 

ix 


X  TABLE  OF  CONTENTS 

SECTION  3 
INNERVATION 

CHAPTER  PAGE 

I     The    Innervation    of    the    Structures    of    the 

Cranium,  Face  and  Neck 111-134 

II     The  Innervation  of  the  Organs  of  the  Thorax   135-142 

III     The  Innervation  of  the  Organs  of  the  Abdomeni43-i56 

I\'     The  Innervation  of  the  Organs  of  the  Pelvis. .    157-161 

SECTION  4 
VERTEBRAL  ^lAL-ALIGNMENT 

I     The  Etiolog}'  of  Abnormal  Nerve  Function.  .  .    163-170 
II     A^ertebral  ]\Ial-Alignnient 171-178 

III  The  External  Causes  of  A'ertebral  ]\Ial-Align- 

ment 179-187 

IV  The  Internal  Causes  of  A'ertebral  Mal-Align- 

ment 188-198 

\'     The  Local  Effects  of  Mal-Alignment  of  Verte- 
brae       199-202 

VI     The  Eft'ect  of  A'ertebral  Subluxations  on  Nerve 

Function   203-212 

SECTION  5 

SPINAL  ANALYSIS 

I     Segmentation  and  Localization 213-238 

II     Spinal  Symptomatology 239-247 


TABLE  OF  CONTENTS  xi 

CHAPTER  PAGE 

III  Spinal  Diagnosis 248-255 

IV  Vertebral  Subluxation   256-278 

V     Spinal  Analysis 279-3 14 


SECTION  6 
SPINAL  ADJUSTMENT 

I  General  Considerations 315-321 

II  Adjustment  of  the  Cervical  Vertebrae 322-340 

III  Adjustment  of  the  Thoracic  \'ertebrae 341-364 

IV  Adjustment  of  the  Lumbar  A^ertebrae 365-377 

V  Regional  Classification  of  Holds 378-382 

SECTION  7 
PRACTICE  OF  SPINAL  ADJUSTMENT 

I  Vertebral  Subluxations  and  Disease 383-389 

II  Infectious  Diseases 390-412 

III  Diseases  Caused  by  Animal  Parasites 413-416 

IV  The  Intoxications  and  Sunstroke 417-420 

V  Constitutional  Diseases 421-428 

VI  Diseases  of  the  Resjiiratory   System 429-441 

ATI  Diseases  of  the  Circulatory  System 442-455 

\TII  Diseases  of  the  Digestive  System 456-4S4 

IX  Diseases  of  the  Nervous  System 485-511 

X  Diseases  of  the  Blood  and  Ductless  Glands.  .  .  512-518 


xii  TABLE  OF  CONTENTS 

CHAPTER  PAGE 

XI     Diseases  of  the  Genito-Urinary  System 519-530 

XII     Diseases  of  the  Eye  and  Ear 531-53^ 

XIII  Gynecological  Diseases 537-550 

XIV  Diseases  and   Injuries  of  the  Spine  and   De- 

formities    551-564 

XV     Diseases  of  the  Skin 565-573 


LIST  OF  ILLUSTRATIONS 


FIG.  PAGE 

1  Back  Showing  Subluxations  Found  on  Cadaver 20 

2  Cadaver  with  First  Layer  of  Muscles  Revealed 22 

3  Cadaver  with  Second  Layer  of  Muscles  Revealed 24 

4  Cadaver  with  Third  Layer  of  Aluscles  Revealed 26 

5  Cadaver  with  Fourth  Layer  of  Muscles  Revealed 28 

6  Cadaver  with  Fifth  Layer  of  Muscles  Revealed 30 

7  Left  Half  of  Torso  Showing  Spine 32 

8  The  Spine  Showing  Narrowed  Foramina 34 

9  A  Group  of  Subluxated  Vertebrae 36 

10  The  Sympathetic  Nervous  System  (Gray) 48 

11  Parts  Influenced  by  the  First  Cervical  Nerve 112 

12  Parts  Influenced  by  the  Second  Cervical  Nerve 114 

13  Parts  Influenced  by  the  Third  Cervical  Nerve 116 

14  Parts  Influenced  by  the  Fourth  Cervical  Nerve 118 

15  Parts  Influenced  by  the  Fifth  Cervical  Nerve 120 

16  Parts  Influenced  by  the  Sixth  Cervical  Nerve 122 

17  Parts  Influenced  by  the  Seventh  Cervical  Nerve 124 

18  Parts  Influenced  by  the  Eighth  Cervical  Nerve 126 

19  Parts  Influenced  by  the  First  Dorsal  Nerve 128 

20  Parts  Influenced  by  the  Second  Dorsal  Nerve 130 

21  Parts  Influenced  by  the  Third  Dorsal  Nerve 132 

xiii 


xiv  LIST  OF  ILLUSTRATIONS 

FIG.  PAGE 

22  Parts  Influenced  by  the  Fourth  Dorsal  Nerve 134 

23  Parts  Influenced  by  the  Fifth  Dorsal  Nerve 136 

24  Parts  Influenced  by  the  Sixth  Dorsal  Nerve 138 

25  Parts  Influenced  by  the  Seventh  Dorsal  Nerve 140 

26  Parts  Influenced  by  the  Eighth  Dorsal  Nerve 142 

27  Parts  Influenced  by  the  Ninth  Dorsal  Nerve 144 

28  Parts  Influenced  by  the  Tenth  Dorsal  Nerve 146 

29  Parts  Influenced  by  the  Eleventh  Dorsal  Nerve 148 

30  Parts  Influenced  by  the  Twelfth  Dorsal  Nerve 150 

31  Parts  Influenced  by  the  First  Lumbar  Nerve 152 

32  Parts  Influenced  by  the  Second  Lumbar  Nerve 154 

33  Parts  Influenced  by  the  Third  Lumbar  Nerve 156 

34  Parts  Influenced  by  the  Fourth  Lumbar  Nerve 158 

35  Parts  Influenced  by  the  Fifth  Lumbar  Nerve 160 

36  Phantom  of  the  Nervous  System 164 

}J     The  Normal  Spine 172 

38  Anterior  Aspect  of  Spine  Showing  Subluxations 174 

39  Posterior  Aspect  of  Spine  Showing  Subluxations 176 

40  Lateral  Aspect  of  Spine  Showing  Subluxations 177 

41  Segmentation  Chart 252 

42  Kyphotic  Subluxation ....    262 

43  Lordotic    Subluxation 264 

44  Scoliotic  Subluxation 265 

45  Compression  Subluxation 267 

46  Supero-Inferior  Subluxation 269 

47  Lateral  Subluxation 271 


LIST  OF  ILLUSTRATIONS  XV 

FIG.  PAGE 

48  Anterior    Subluxation 272 

49  Posterior  Subluxation 274 

50  Rotary  Subluxation ". 275 

51  Palpation  of  the  Transverse  Processes 286 

52  The  Adams  Position 288 

53  The  Erect  Position 290 

54  Spinal  Adjustment  Table 292 

55  Spinal  Adjustment  Table 294 

56  Prone  Position — Palpation  of  the  Spinous  Processes..   296 

57  Palpation  of  the  Transverse  Processes 298 

58  Palpation  of  the  Cervical  \^ertebrae 306 

59  Spinal  Analysis  Chart 308 

60  Signs  Showing  A'arious  Subluxations 310 

61  Record  of  Spinal  Analysis 312 

62  Contact  Points  of  the  Hand 320 

63  Temporo-Transverse  Hold 323 

64  Temporo-Transverse  Hold 324 

65  Fronto-Tranverse   Hold 325 

66  Parieto-Transverse   Hold 326 

67  Bilateral  Pisiform-Transverse  Anterior  Hold 327 

68  Alalar-Transverse   Hold 330 

69  Malar-Transverse   Hold 33 1 

70  Unilateral  Pisiform-Transverse  Hold 332 

71  Temporo-Centrum  Hold 333 

72  Occipito-Mandibular  Hold  A 336 

73  Occipito-Mandibular  Hold  B 2,-^^ 


xvi  LIST  OF  ILLUSTRATIONS 

FIG.  PAGE 

74  Occipito-Mandibular  Hold  C .  .  330 

75  Temporo-Occipital  Hold 339 

76  Thumb-Transverse   Hold 342 

yy     Crossed  Thumb-Transverse  Hold 343 

78  Crossed  Bilateral  Pisiform-Transverse  Hold 344 

79  Pisiform-Spinous  Hold 345 

80  Unilateral  Pisiform-Transverse  Hold 348 

81  Ulno-Spinous  Hold 349 

82  Calcaneo-Pisiform-Transverse   Hold 350 

83  Bilateral  Digito-Transverse  Hold 351 

84  T.  M.  Hold 354 

85  Mandibulo-Spinous  Hold 355 

86  Calcaneo-Spinous  Hold 356 

87  Sacro-Spinous   Hold 357 

88  Thoracic  Extension  Hold  i 360 

89  Thoracic  Extension  Hold  2 361 

90  The  Recoil  Hold 362 

91  Bilateral  Pisiform-Transverse  Hold 366 

92  Ulno-Spinous  Hold 367 

93  Ilio-Spinous   Hold 368 

94  Supra-Sacral  Hold 369 

95  Supra-Iliac  Hold 372 

96  Infra-Iliac  Hold 373 

97  Genu-Spinous  Hold 374 

98  Ilio-Deltoid  Hold 375 

99  Genu-Deltoid   Hold 376 


SECTION  ONE 

Principles  of  Chiropractic 


CHAPTER  I 
The  Origin  of  Chiropractic 

Chiropractic  (G.  chcir,  hand  and  praktikos,  efficient)  is 
the  art  and  science  of  treating  disease  by  the  adjustment  of 
displaced  vertebrae,  thereby  reHeving  impingement  of  the 
nerves  passing  through  the  intervertebral  foramina. 

Nothing  definite  is  known  as  to  where  or  when  chiropractic 
was  first  used  or  who  was  the  originator  of  this  method  of 
treating  disease.  Its  value  as  a  curative  measure  was  prob- 
ably first  ascertained  when  its  employment  was  directed 
toward  the  relief  merely  of  sprains  and  other  injuries  of  the 
vertebral  column.  Patients  who  were  being  treated  for  the 
relief  of  such  vertebral  lesions  were  often  suffering  from 
coincident  affections  of  various  kinds.  In  such  cases  it  was 
found  that,  many  times,  diseases  other  than  the  spinal  injury 
itself  also  responded  to  the  manipulation  of  the  vertebrae. 
Thus  its  value  as  a  curative  agent  was  first  brought  to  the 
notice  of  those  using  this  method. 

Its  wide  range  of  usefulness  becoming  more  and  more 
recognized,  its  use  became  more  and  more  general,  until  we 
find  it  employed  not  merely  by  a  few  individuals  but  by  the 
people  of  an  entire  nation.  Many  anecdotes  are  told  regarding 
its  efficiency  among  especially  the  inhabitants  of  Bohemia. 
By  some  authorities  this  latter  country  is  regarded  as  the 
birth-place  of  this  science.  Others,  however,  affirm  that 
spinal  manipulations  for  the  cure  of  disease  were  used  by  the 
Germans  for  many  years  before  it  was  heard  of  in  Bohemia. 
Still  others  state  that  during  a  sojourn  among  the  Indians 
they  were  told  by  them  that  methods  similar  to  the  chiroprac- 
tic treatments  of  the  present  day  were  in  common  use  among 
their  tribes  for  as  long  as  these  aborigines  could  remember. 

1 


2  SPINAL  ADJUSTMENT 

Thus  we  are  told  of  a  cruel  application  of  spinal  treatment 
by  the  Indians.  It  consisted  in  the  patient  being  tied  to  a 
tree,  and  his  back  being  then  vigorously  pounded.  Another 
way  in  which  adjustment  was  attempted,  was  the  following: 
The  patient  would  lie  upon  the  floor  while  another  walked 
on  his  back,  one  foot  being  placed  on  either  side  of  the  spinous 
processes. 

Coming  down  to  more  modern  times,  we  are  all  more  or 
less  familiar  with  the  fact  that  among  athletes  forcible  strik- 
ing of  the  back  on  each  side  of  the  spinous  processes  is  often 
resorted  to  for  the  purpose  of  restoring  to  normal  the  action 
of  the  heart  and  respiration  of  one  of  their  number  who  is 
injured. 

These  are  all  examples  of  different  ways  in  which  the  same 
end  was  sought,  namely  the  adjustment  of  subluxated  verte- 
brae. While  the  methods  used  do  not  resemble  in  the  slightest 
degree  the  modern  chiropractic  adjustment  of  the  present 
day,  the  results  obtained  were  sufificiently  encouraging  to 
perpetuate  their  employment. 

The  Bohemians  were  probably  the  first  to  use  a  definite 
"thrust"  upon  such  vertebrae  as  they  found  displaced.  But 
they  also,  although  ignorant  of  the  real  reason  for  giving  the 
thrust,  applied  it  because  they  had  come  to  know  that  in  so 
many  instances  its  use  was  followed  by  a  cure  of  the  ailment 
from  which  the  patient  suffered.  Not  only  did  they  use  the 
thrust  for  the  relief  of  spinal  injuries  and  diseases  but  also 
for  its  general  stimulating  effects. 

In  the  light  of  our  present  day  methods,  these  means  of 
accomplishing  the  desired  end,  namely  the  adjustment  of 
subluxated  vertebrae,  were  crude  indeed.  But  it  must  be 
remembered  that  to  those  who  employed  the  methods  de- 
scribed the  underlying  cause  was  unknown.  They  simply 
knew  that  striking  the  back,  walking  over  the  patient's  spine, 
et  cetera,  produced  the  desired  effect.  But  why  or  how  it 
produced  such  an  effect  they  did  not  know. 

Nevertheless,  these  procedures,  crude  and  unscientific 
though  they  were,  tended  to  restore  the  ligaments  of  each 
side  of  the  vertebral  column  to  balanced  tonicity ;  they  reduced 
subluxated  vertebrae  and  thus  relieved  the  impingement  upon 
the  nerves  passing  through  the  intervertebral  foramina.     In 


ORIGIN  OF  CHIROPRACTIC  3 

short,  the  empirical  use  of  chiropractic  preceded,  by  many 
years,  its  scientific  explanation;  a  circumstance,  by  the  way, 
which  holds  true  in  the  entire  history  of  the  healing  art. 

Thus  chiropractic  remained,  for  many  years,  in  ignorant 
hands.  Nothing  was  written  concerning  this  new  method 
of  treating  disease,  and  the  regular  system  of  healing  never 
recognized  it.  In  fact,  it  was  looked  upon  as  a  form  of  quack- 
ery, and  physicians  would  have  nothing  to  do  with  it.  As  a 
result,  what  was  destined  to  become  a  most  valuable  acquisi- 
tion to  the  armamentarium  of  those  engaged  in  the  art  of 
healing,  remained  unnoticed  by  those  best  fitted,  in  those  days, 
to  place  it  upon  a  scientific  basis. 

There  was  nothing  surprising  in  this  when  one  stops  to 
consider  with  what  extreme  difficulties  he  is  beset  who  de- 
sires to  receive  recognition  for  some  new  method  of  therapy. 
Many,  indeed,  are  averse  to  adopting  anything  new  no  matter 
what  possibilities  it  holds  forth.  And  many  a  well-meaning 
physician  will  promptly  condemn  chiropractic  without  grant- 
ing the  method  an  opportunity  to  demonstrate  any  possible 
merit  it  may  possess. 

While  the  above  may  seem  like  a  digression  from  the  sub- 
ject in  hand,  it  is  deemed  worthy  of  mention  for  the  reason 
that  it  throws  a  strong  light  on  the  cause  of  the  long  delay  in 
the  recognition  of  chiropractic.  But  aside  from  all  this,  the 
empirical  beginnings  of  this  method  were  also  largely 
instrumental  in  keeping  it  back. 

Again,  when  first  introduced  into  this  country  it  was  spon- 
sored by  men  of  little  or  no  education.  Furthermore,  on  seeing 
some  instances  of  what  it  accomplished,  its  advocates  at  once 
jumped  to  the  conclusion  that  spinal  adjustment  would  "cure" 
all  diseases.  It  was  rather  natural,  therefore,  that  such  ex- 
travagant claims  should  have  been  met  by  the  condemnation 
which  they  received  at  the  hands  of  the  medical  profession. 

Once  more,  osteopathy  claims  that  chiropractic  is  but  a 
branch  of  that  science.  A  most  careful  review  of  osteopathic 
literature  fails  to  disclose  the  slightest  reference  to  any  mode 
of  treatment  resembling  the  chiropractic  thrust.  And  while 
it  is  true  that  recent  books  on  osteopathy  dwell  at  some  length 
on  the  application  of  the  chiropractic  thrust,  it  is  nevertheless 
a  fact  that  osteopathy  took  no  notice  of  it  until  chiropractors 


4  SPINAL  ADJUSTMENT 

had  popularized  spinal  adjustment  sufficiently  to  make  its  use 
"worth  while." 

The  art  of  spinal  adjustment  was  originally  introduced  to 
this  country  by  D.  D.  Palmer,  who  died  in  1912.  He  had 
heard  of  this  form  of  treating  disease  from  a  Bohemian,  and 
he  conceived  the  idea  of  moulding  the  information  thus  ob- 
tained into  a  system  of  healing.  He  classified  the  various 
kinds  of  possible  displacements  of  the  vertebrae,  and  devised 
thrusts  suitable  to  their  reduction.  Palmer,  however,  fell 
into  one  serious  error.  He  did  as  so  many  before  him  have 
done.  He  became  overzealous.  He  claimed  that  all  disease 
is  due  to  subluxations  of  the  vertebrae  and  that  all  diseases 
could  be  eradicated  by  adjustment  of  the  vertebrae.  Naturally, 
such  views  could  not  be  subscribed  to  by  anyone  with  a  liberal 
training  in  the  sciences  underlying  the  art  of  healing,  and  espe- 
cially, one  with  a  knowledge  of  pathology.  This  preliminary 
training  Palmer  lacked ;  and  it  goes  without  saying  that  had  he 
possessed  such  knowledge,  he  would  not  have  made  the  claims 
which  he  did.  He  derided  all  other  forms  of  therapy,  and 
persisted  in  his  original  views  to  the  end.  Nevertheless,  while 
the  advancement  made  in  chiropractic  technique  has  been  very 
great,  and  broader  views  now  obtain  among  the  profession 
as  a  whole,  still  to  Palmer  must  be  given  the  credit  for  fur- 
nishing the  impetus  which  carried  chiropractic  to  a  recognition 
of  its  wonderful  possibilities. 

It  was,  however,  only  natural  that  of  all  his  disciples  there 
should  be  some  who  could  not  agree  with  Palmer's  views  in 
their  entirety.  And  such  a  condition  of  afifairs  really  did  arise. 
There  were  some  who  devised  what  they  considered  more 
accurate  methods  of  spinal  analysis  to  determine  the  existence 
of  possible  subluxations.  Others  originated  different  thrusts 
for  the  adjustment  of  the  different  kinds  of  subluxations.  Still 
others,  in  addition  to  making  changes  in  the  manner  of  pal- 
pating and  the  form  of  thrusts  applied,  incorporated  adjunct 
methods  of  physiological  therapy,  such  as  attention  to  diet, 
hydrotherapy,  massage,  et  cetera. 

At  the  present  time  chiropractic  is  practiced  by  several 
thousands  of  graduates.     By  the  results  achieved  it  has  dem- 
onstrated in  an  unmistakable  manner  that  of  all  therapeutic 
measures  cliiropractic  accomplishes  more  than  any  other  single 
agent. 


CHAPTER  II 

The  Theoretical  Basis  of  Chiropractic 

As  stated  at  the  commencement  of  the  preceding  chapter, 
chiropractic  is  founded  on  the  theory  that  vertebrae  may  be- 
come subliixated,  that  is  to  say,  that  a  slight  displacement  of 
their  opposing  articular  surfaces  may  occur. 

As  a  consequence  of  this  subluxation  there  is  produced  an 
impingement  upon  the  nerves  which  pass  through  the  inter- 
vertebral foramen  corresponding  to  the  vertebrae  involved  in 
the  displacement.  This  impingement  is  a  direct  result  of 
the  pressure  produced  by  the  altered  position  of  the  margins 
of  the  intervertebral  foramen. 

In  order  to  appreciate  exactly  how  such  displacement  of 
the  vertebrae  could  produce  impingement  upon  the  spinal 
nerve,  a  study  of  the  parts  of  the  vertebra  which  enter  into 
the  formation  of  the  intervertebral  foramen  is  necessary.  A 
portion  of  the  circumference  of  the  foramen  is  forrned  by  the 
intervertebral  notches  which  are  concavities  on  the  upper 
and  under  surfaces  of  the  pedicles.  The  pedicles  are  two  short, 
thick  processes  of  bone,  which  project  backward,  one  on  each 
side,  from  the  upper  part  of  the  body  of  the  vertebra,  at  the 
line  of  union  of  its  posterior  and  lateral  surfaces.  The  inter- 
vertebral notches  are  four  in  number,  two  on  each  side,  the 
inferior  ones  being  generally  the  deeper.  When  the  vertebrae 
are  articulated  the  notches  of  each  contiguous  pair  of  bones 
form  the  upper  and  lower  border  of  the  intervertebral  fora- 
men. The  articular  processes  of  the  vertebrae  are  nearly 
vertical,  and  project  from  the  upper  and  lower  surfaces  of  the 
pedicles.  A  part  of  the  margin  of  the  articular  process  thus 
forms  a  portion  of  the  margin,  namely  the  posterior  portion 
of  the  intervertebral  foramen.  The  anterior  part  of  the  wall 
of  the  intervertebral  foramen  is  formed  by  the  body  of  the 
vertebra  and  the  intervertebral  disc. 

From  the  above  description  it  is  seen  that  the  intervertebral 
foramen  is  bounded  above  and  below  by  the  pedicles,  posteri- 

5 


6  SPINAL  ADJUSTMENT 

orly  by  the  articular  process,  and  anteriorly  by  the  body  and 
intervertebral  disc. 

Since  the  anterior  surface  of  the  articular  process  consti- 
tutes the  posterior  wall  of  the  intervertebral  foramen,  it  can 
be  easily  understood  how  the  slightest  forward  displacement 
of  a  vertebra  would  cause  the  articular  process  to  encroach 
on  the  anbero-posterior  diameter  of  the  intervertebral  foramen, 
and  press  upon  the  spinal  nerve  at  that  point. 

In  like  manner,  since  the  pedicles  form  the  upper  and  lower 
walls  of  the  intervertebral  foramen,  it  is  at  once  apparent  how 
an  upward  or  a  downward  displacement  of  a  vertebra  would 
cause  the  pedicles  to  encroach  on  the  vertical  diameter  of  the 
foramen.  In  such  a  case  the  spinal  nerve  is  pressed  upon  by 
the  pedicles,  either  the  lower  or  upper  one,  as  the  displacement 
is  either  upward  or  downward. 

Lastly,  since  the  body  of  the  vertebra  forms  the  anterior 
wall  of  the  intervertebral  foramen,  it  is  clear  that  a  backward 
displacement  of  a  vertebra  would  result  in  the  posterior  sur- 
face of  the  body  encroaching  on  the  antero-posterior  diameter 
of  the  foramen,  and  press  upon  the  spinal  nerve. 

It  is  a  well  known  fact  that  nature  permits  of  no  spaces 
in  the  body  left  unoccupied.  Consequently,  the  intervertebral 
foramen  must  not  be  looked  upon  as  a  circular  opening  with  a 
nerve  passing  through  its  center.  On  the  contrary  it  is  en- 
tirely occupied  by  the  structures  which  pass  through  it. 
Nature  wastes  no  space,  and  no  cavity  or  foramen  in  the  entire 
body  is  larger  than  is  required  for  the  holding  of  the  struc- 
tures which  it  contains  or  transmits.  Thus  the  intervertebral 
foramen  is  only  of  sufficient  size  to  contain  the  vessels  and 
nerves  which  it  transmits,  and  a  decrease  in  the  size  of  the 
foramen  results  in  a  diminution  of  the  space  required  by  the 
nerves  for  the  exercise  of  their  normal  function. 

That  part  of  the  vertebra  which  is  displaced  and  encroaches 
upon  the  diameter  of  the  foramen  presses  upon  the  spinal 
nerve.  It  must  be  borne  in  mind  that  the  margins  of  the  inter- 
vertebral foramen  are  not  sharp,  but  smooth  and  rounded. 
Consequently  the  pressure  upon  the  nerve  of  the  displaced 
portion  of  the  circumference  of  the  foramen  does  not  sever 
the  continuity  of  the  nerve,  but  results  in  an  impairment"  of 
its  power  of  conductivity. 


THEORETICAL  BASIS  OF  CHIROPRACTIC  7 

Therefore,  chiropractic  maintains  that  when,  as  a  result 
of  a  displacement  of  a  vertebra,  the  nerve  is  impinged,  as 
above  described,  it  is  prevented  from  conveying  impulses  to 
those  parts  which  it  controls.  This  opinion  is  based  upon 
the  physiological  fact  that  mechanical  applications  to  a  nerve 
first  increase  and  later  lessen  and  destroy  its  irritability.  Irri- 
tability is  that  property  of  living  protoplasm  which  causes  it 
to  undergo  characteristic  physical  and  chemical  changes  when 
it  is  subjected  to  certain  influences,  called  irritants.  The 
term  irritants,  in  speaking  of  nerves,  includes  anything  which 
causes  the  nerve-cell  to  send  an  impulse  along  its  branches. 
Consequently  when  chiropractic  states  that  pressure  upon  a 
nerve  interferes  with  its  power  to  transmit  impulses  it  does 
so  in  full  accord  with  the  further  physiological  fact  that  pres- 
sure gradually  applied  to  a  nerve  first  increases  and  later  re- 
duces its  power  to  respond  to  irritants.  If  the  power  of  a 
nerve  to  respond  to  irritants  is  lost,  it  assuredly  is  unable  to 
carry  impulses,  for  upon  its  irritability  depends  its  power 
to  generate  impulses  or  convey  them. 

Assuming,  then,  for  the  moment,  that  subluxations  really 
may  occur,  and  that  as  a  result  of  these  subluxations  of  the 
vertebrae  an  impingement  upon  the  spinal  nerve  is  produced, 
chiropractic  maintains  that  disease  results  in  that  particular 
part  or  organ  controlled  by  the  spinal  segment  involved  in  the 
displacement. 

This  must  follow  because  the  normal  function  and  the 
organic  integrity  of  every  organ  and  part  of  the  body  is  de- 
pendent upon  proper  innerv^ation  without  which  health  cannot 
be  preserved.  The  medium  through  which  this  state  of  per- 
fect equilibrium  of  the  various  parts  of  the  body  is  maintained 
is  the  sympathetic  nervous  system.  This  portion  of  the  nerv- 
ous system  is  the  mechanism  which  governs  every  unconscious 
act  of  the  body.  It  regulates  the  proper  circulation  of  the 
blood,  secretion,  excretion,  and  metabolism.  This  is  accom- 
plished by  a  constant  stream  of  out-going  impulses,  the  ex- 
istence of  which  is  proven  by  the  fact  that  under  normal 
conditions  both  the  voluntary  and  involuntary  muscles  are  in 
a  state  of  slight  contraction  or  tonus  at  all  times. 

The  human  organism  is  regarded  generally  as  a  machine 
made  up  of  various  parts.    When  these  parts  are  functioning 


8  SPINAL  ADJUSTMENT 

as  a  harmonious  whole,  health  exists.  When,  on  the  contrary 
a  lack  of  balance  is  present,  there  is  a  perversion  of  function, 
and  what  we  know  as  disease  develops. 

We  have  said  that  the  regulation  of  all  these  various  func- 
tions of  the  body  economy  depends  upon  a  perfect  and  un- 
interrupted flow  of  impulses  along  the  course  of  the  nerves. 
Any  interference  with  the  free  and  continuous  transmission 
\,-j  ofThese^inpTilsesTa^Tytiring,  liTotherwords,  which  diminishes 
Vv  the  pow^r-€rf-cOn duct ivity  of  the  nerves,  must  be  regarded  as 
-^  the  true  cause  of  disease.  The  only  place  where  such  inter- 
lerBllce  can  logically  ^ccur  is  at  the  intervertebral  foramina, 
for  in  no  other  place  along  their  entire  course  are  the  nerves 
placed  in  a  position  where  there  exists  the  possibility  of 
pressure  upon  them  of  displaced  bony  structures. 

An  isolated  organ  or  viscus  will  not  functionate  even 
though  all  the  functional  elements  are  present  and  its  integrity 
has  not  been  interfered  with  in  the  slightest  degree.  Of  itself 
it  has  no  power  to  act,  and  when  separated  from  the  body  it 
becomes  an  inanimate  mass  of  specialized  cells  which  from 
that  moment  forth  not  only  lose  their  ability  to  exercise  their 
normal  function  but  their  very  existence  itself,  and  disintegra- 
tion rapidly  follows.  The  functional  ability  of  an  organ 
depends  upon  the  vital  force  inherent  in  the  living  organism  as 
a  whole,  which  acts  through  the  medium  of  the  brain.  Here  the 
impulses  are  generated  which  govern  the  activity  of  the  body 
economy,  and  these  impulses  are  conveyed  along  the  course 
of  the  nerves  to  every  cell.  Without  these  impulses  the  cell 
would  cease  to  act  and  cease  to  be.        '=^-\ 

In  view  of  these  facts  the  factors  commonly  considered  as 
the  cause  of  disease  are  not  the  real  cause,  but  merely  sec- 
ondaryTacToTS  acting^  opel^atmg  by^virtue  of  the  presence 
in  the  body  of  conditions  which  make  their  activity  possible. 
These  conditions  are  produced  primarily  by  a  want  of  resist- 
ance to  the  invasion  of  the  secondary  factors,  as  a  result  of 
deficient  innervation  of  the  part  involved.  Thus,  for  example, 
in  pneumonia  which  is  ordinarily  considered  as  being  caused 
by  the  pneumococcus  of  Fraenkel,  the  pneumococcus  is  not 
the  primary  or  direct  cause  of  the  disease;  were  this  true 
nearly  every  individual  would  "catch"  this  disease,  since  we 
are  constantly  brought  into  contact  with  this  organism.  There 


THEORETICAL  BASIS  OF  CHIROPRACTIC  9 

must,  therefore,  be  something  which  prevents  certain  individ- 
uals from  becoming  affected  with  pneumonia,  and  which 
makes  it  possible  for  others  to  contract  the  disease.  This 
something  is  the  resistance  of  the  former  and  the  want  of  such 
resistance  in  the  latter.  It  may  be  questioned  why  do  some 
recover  from  the  disease,  while  others  succumb  to  it.  Once 
again  the  answer  is  simply  that  in  the  case  of  the  patient  who 
recovers  a  sufficient  amount  of  resistance  was  possessed  to 
overcome  the  deleterious  influences  of  the  micro-organism  and 
its  toxins.  In  the  case  of  the  patient  who  succumbed  to  the 
disease  this  resistance  was  not  present;  in  other  words  his 
bodily  state  as  a  whole  was  such  as  to  make  it  possible  for  the 
secondary  factors  to  obtain  a  foothold  and  make  their  de- 
structive influences  possible. 

■Xiack  of  resistance,  then,  is  the  primary  factor  ijijthe  pro- 
(juction  of  disease,  smce  in  the  face  of  a  perfect  resistance  the 
action  of  the  secondary  factors  become  impossible.  Resistance 
thus  becomes  but  another  term  for  perfect  metabolism,  per- 
fect functioning  of  the  organs  of  the  body;  and  a  perfectly 
harmonious  whole.  This  perfect  state  of  the  body  economy 
we  have  seen  depends  upon  a  free  and  uninterrupted  flow  of 
nerve  impulses.  Anything,  therefore,  which  interferes  with 
the  conductivity  of  the  nerves  must  be  considered  as  being  the 
primary  cause  of  disease.  The  place  at  which  this  interference 
occurs  is  at  the  point  where  the  spinal  nerve,  and  the  sym- 
pathetic fibers  in  the  substance  of  the  spinal  nerve,  pass 
throug^h  the  intervertebral  foramen. 

In  order  to  appreciate  the  exact  manner  in  which  the  sym- 
pathetic system  is  influenced  by  a  subluxated  vertebra  brief 
consideration  of  the  connection  between  the  cerebro-spinal 
and  sympathetic  nervous  systems  must  be  included  in  this 
chapter. 

The  spinal  nerve,  formed  by  the  union  of  the  anterior  and 
posterior  roots  which  originate  in  the  anterior  and  posterior 
horns  of  the  spinal  cord  respectively,  passes  through  the 
intervertebral  foramen.  After  its  complete  emergence  from 
the  foramen  it  bifurcates  into  the  anterior  and  posterior  pri- 
mary divisions.  The  anterior  root  of  the  spinal  nerve  is 
efferent  or  motor;  the  posterior  is  afferent  or  sensory.  Situ- 
ated  on  the  posterior  root   is  a   ganglion   called   the   spinal 


10  SPINAL  ADJUSTMENT 

ganglion.  That  portion  of  the  sympathetic  system  with  which 
we  are  now  engaged  consists  of  (1)  a  series  of  ganglia,  joined 
to  each  other  by  intervening  cords,  extending  from  the  base 
of  the  skull  to  the  coccyx,  one  on  each  side  of  the  middle  line 
of  the  body,  partly  in  front  and  partly  on  each  side  of  the 
vertebral  column ;  (2)  of  numerous  nerve-fibres,  which  are 
of  two  kinds :  namely,  communicating,  by  means  of  which 
the  ganglia  communicate  with  each  other  and  the  cerebro- 
spinal nerves,  and  distributory,  which  supply  the  internal 
viscera  and  the  coats  of  the  blood-vessels.  The  sympathetic 
fibres  are  also  both  efferent  and  afferent.  The  efferent  or 
white  branches  of  communication  between  the  ganglia  and 
the  cerebro-spinal  nerves  arise  in  the  spinal  cord;  they  pass 
out  in  the  anterior  root,  and  then  into  the  spinal  nerve.  Here 
they  join  the  afferent  fibres  which  originate  in  the  spinal 
ganglion.  These  united  fibres  then  pass  on  into  the  anterior 
primary  division  of  the  spinal  nerve.  They  leave  this,  and, 
now  being  known  as  the  white  rami  communicantes,  they  pass 
to  the  ganglion  of  the  sympathetic  cord  of  the  corresponding 
situation.  The  afferent  branches  of  communication  between 
the  sympathetic  and  cerebro-spinal  nerves  pass  from  the  gang- 
lion of  the  sympathetic  cord  to  the  spinal  nerve  and  are  called 
the  gray  rami  communicantes.  They  may  extend  separately 
from  the  white  rami,  or  both  kinds  of  fibres  may  be  contained 
in  a  single  bundle.  The  gray  rami  pass  through  the  anterior 
primary  division  of  the  spinal  nerve  to  the  spinal  nerve  and 
then  accompany  it  throughout  all  its  divisions.  The  branches 
between  the  ganglia  themselves  consist  of  gray  and  white 
nerve-fibres,  the  latter  being  a  continuation  of  the  efferent 
fibres  which  pass  from  the  spinal  nerves  to  the  ganglia. 

Situated  in  front  of  the  spine,  in  the  thoracic,  abdominal 
and  pelvic  regions,  are  three  great  gangliated  plexuses.  They 
are  called  the  cardiac,  solar  and  hypogastric  plexuses,  re- 
spectively. They  are  made  up  of  nerves  and  ganglia ;  the 
nerves  are  derived  from  the  gangliated  cords  and  from  the 
cerebro-spinal  nerves.  These  great  gangliated  plexuses  send 
branches  to  the  viscera. 

Smaller  ganglia  are  found  amidst  the  nerves  in  certain 
viscera,  and  form  additional  centres  for  the  origin  of 
nerve-fibres. 


THEORETICAL  BASIS  OF  CHIROPRACTIC  11 

The  branches  of  distribution  from  the  gangliated  cords,  from 
the  great  gangHated  plexuses,  and  from  the  smaller  ganglia, 
supply  impulses  to  the  involuntary  muscular  coats  of  the  blood- 
vessels, all  hollow  viscera,  and  the  secreting  cells  of  all  glands. 

Thus  we  see  that  the  two  systems  are  interlocked  in  the 
most  intimate  manner.  Branches  pass  from  the  spinal  nerve 
to  the  ganglion,  and  from  the  ganglion  to  the  spinal  nerve,  re- 
sulting in  a  double  interchange  between  them.  In  this  way 
they  really  constitute  one  composite  system,  and  impulses 
from  the  brain  which  are  arrested  at  the  intervertebral  fora- 
men by  a  subluxation  of  a  vertebra  must  of  necessity  cause 
disturbances  in  the  parts  of  the  body  governed  by  that  segment 
which  is  involved  in  the  subluxation. 

The  foregoing  applies  exclusively  to  the  thoracic,  abdom- 
inal and  pelvic  viscera.  How  the  structures  of  the  head  and 
face  are  influenced  must  also  be  briefly  shown. 

Each  gangliated  cord  enters  the  cranium  through  the 
carotid  canal  by  an  ascending  branch.  The  two  cords  are 
united  within  the  cranium  by  these  ascending  branches  unit- 
ing in  a  small  ganglion,  called  the  ganglion  of  Ribes.  The 
ganglia  of  the  gangliated  cords  are  classed  as  cervical,  dorsal, 
lumbar,  and  sacral.  We  concern  ourselves  in  this  connection 
with  only  the  cervical  portion  which  has  three  pairs  of  ganglia. 
These  three  pairs  of  ganglia  are  classified  from  their  position 
as  the  superior,  middle,  and  inferior. 

The  superior  cervical  ganglion  which  is  the  largest  of  the 
three  is  situated  opposite  the  second  and  third  cervical  verte- 
brae. It  is  commonly  supposed  that  it  is  formed  by  a  coal- 
escence of  the  four  ganglia  corresponding  to  the  four  upper 
cervical  vertebrae.  It  has  five  branches,  namely,  superior, 
inferior,  anterior,  internal,  and  external.  These  branches  form 
plexuses  which  send  filaments  to  all  the  cranial  nerves.  There 
is  thus  formed  a  connection  between  the  cranial  nerves  and  the 
sympathetic  system  as  intimate  as  that  which  we  have  seen 
exists  between  the  spinal  nerves  and  the  sympathetic  system. 
By  reason  of  this  intimate  relationship  it  is  possible  to  directly 
influence  the  cranial  nerves  by  adjustment  of  the  cervical 
vertebrae.  And  it  is  a  clinical  fact  that  in  nearly  all  affections 
involving  the  structures  of  the  head  and  face,  such  as  the  ear, 
eye,  nose,  and  throat,  subluxations  exist,  and  that,  moreover 


12  SPINAL  ADJUSTMENT 

adjustment  of  subluxated  vertebrae  is  followed  by  a  cure  or 
improvement  in  the  particular  disease  thus  produced. 

The  question  which  now  naturally  arises,  is,  does  the 
vertebral  subluxation  cause  enough  actual  pressure  to  be 
brought  to  bear  upon  the  spinal  nerve  to  inhibit  its  power 
of  transmitting  impulses  This  question  will  be  answered  in 
detail  in  a  future  chapter.  One  fact  will,  however,  be  men- 
tioned at  this  time  to  demonstrate  that  it  is  possible  for  suffi- 
cient pressure  to  occur  to  impede  the  flow  of  impulses  along 
the  nerve  impinged.  The  intervertebral  foramen  of  the  adult 
human  spine  is  from  1/6  to  1/4  inch  in  diameter.  The  spinal 
nerve  measures  1/12  inch  in  diameter  at  its  narrowest  point, 
and  1/6  inch  at  its  widest  point.  It  is  placed  in  such  a  posi- 
tion that  it  does  not  come  into  actual  contact  with  the  bony 
boundary  of  the  foramen  -at  any  point.  But  it  can  be  demon- 
strated mathematically  that  its  farthest  distance  from  the  wall 
of  the  foramen  is  only  1/8  of  an  inch,  while  only  1/32  of  an 
inch  intervenes  between  it  and  the  wall  of  the  foramen  at 
the  point  where  it  lies  nearest  the  bone.  Now,  when  we  con- 
sider that  in  addition  to  the  spinal  nerve,  the  intervertebral 
foramen  also  contains  blood-vessels,  fat  cells,  and  fibrous 
tissue,  it  at  once  becomes  apparent  that  it  requires  only  a  very 
slight  movement  of  the  vertebra  in  any  direction  to  result  in 
sufficient  pressure  upon  the  spinal  nerve  to  seriously  impair 
its  power  of  conductivity. 

It  has  been  stated  by  some  that  empty  spaces  exist  in  the 
intervertebral  foramen.  This  is,  however,  incorrect  both  from 
an  anatomical  and  a  physical  point  of  view.  The  spaces  seen 
in  the  foramen  when  viewed  through  the  microscope  do  not 
exist  during  life  as  they  appear  in  the  section  of  the  foramen 
prepared  for  microscopical  examination. 

In  the  first  place,  as  previously  stated  in  this  chapter. 
Nature  tolerates  no  vacant  spaces  in  the  body.  What,  then, 
do  the  vacant  spaces  seen  under  the  microscope  contain  when 
the  foramen  is  in  situ?  Partly  distended  blood-vessels  which, 
after  excision  become  empty;  the  remaining  portion  is  occu- 
pied by  lymph.  That  the  nerve  is  surrounded  by  these  soft 
structures  affords  it  no  protection,  for  it  must  be  borne  in 
mind  that  the  pressure  which  occurs  in  a  subluxation  is  that 
of  hard  bone  on  soft  tissues. 


THEORETICAL  BASIS  OF  CHIROPRACTIC  13 

Another  question  that  frequently  arises  is  that  referring  to 
the  absence  of  pain  at  the  point  of  the  subluxation.  It  must 
not  be  supposed  that  simply  because  no  pain  is  present  at 
any  point  along  the  spine  that  no  abnormality  exists  along 
the  course  of  the  spine.  To  do  this  would  be  exactly  the 
same  as  to  maintain  that  because  no  pain  exists  at  the  hip- 
joint  no  lesion  exists  there.  It  is  a  well  known  fact  that 
pain  is  very  often  referred  to  a  point  along  the  course  of  a 
nerve  at  some  distance  from  the  seat  of  the  lesion  which  pro- 
duces the  pain.  Thus  in  many  cases  of  hip-joint  disease  pain 
is  referred  to  the  knee;  and  how  very  often  is  this  fact  not 
overlooked?  In  like  manner,  the  pain  which  is  really  pro- 
duced at  the  place  where  the  nerve  is  impinged  is  interpreted 
by  the  patient  at  the  terminals  of  the  nerve  which  is  impinged, 
and  not  at  the  seat  of  its  production,  namely,  the  intervertebral 
foramen. 

That  subluxations  in  certain  segments  of  the  spine  produce 
certain  diseases  is  attested  to  by  the  fact  that  upon  an  accurate 
determination  of  a  subluxation  in  a  certain  section  of  the 
vertebral  column  an  exact  knowledge  is  gained  as  to  what 
particular  system  or  organ  of  the  body  is  diseased.  Naturally 
the  exact  nature  of  the  disease  cannot  be  determined  in  this 
way.  Thus,  for  example,  when  the  liver  is  afifected — it  may 
be  accurately  determined  that  there  is  an  abnormal  condition 
of  that  organ,  but  whether  this  abnormality  is  cancer  or  con- 
gestion of  the  liver  requires  a  direct  examination  of  the  organ 
itself. 

In  conclusion,  chiropractic  maintains  that  by  a  careful  and 
painstaking  examination  of  the  vertebral  column  as  a  whole, 
and  by  a  palpation  of  the  vertebrae  individually,  the  exact 
nature  of  a  subluxation  can  be  determined.  Possibly  the 
most  convincing  evidences  that  displacements  really  exist  are 
these:  upon  adjustment  of  a  subluxated  vertebra  it  is  noted 
that  the  same  condition  which  was  felt  before  the  vertebra 
was  adjusted,  is  no  longer  present.  To  illustrate:  a  vertebra 
is  found  to  be  displaced  laterally ;  the  proper  chiropractic 
thrust  is  applied  for  the  reduction  of  this  lateral  displacement ; 
the  vertebra  is  then  palpated  again,  and  is  found  to  be  in 
perfect  alignment. 

Another  evidence  that  subluxations  exist  and  produce  the 


14  SPINAL  ADJUSTMENT 

effects  ascribed  to  them  is  the  clinical  fact  that,  conditions 
which  existed  before  an  adjustment  of  the  vertebrae,  disappear 
and  a  return  to  normal  results. 

The  nature  of  the  subluxation  being  determined,  the  proper 
thrust  is  applied,  using  the  spinous  or  transverse  processes 
as  levers.  This  thrust,  by  virtue  of  its  spontaneity,  replaces 
the  vertebra  in  its  proper  position.  Thus  the  size  and  form 
of  the  intervertebral  foramen  is  again  made  normal.  Tlie 
mechanical  pressure  at  the  foramen  is  removed  and  a  free  and 
uninterrupted  flow  of  impulses  along  the  nerve  is  made 
possible. 

William  Jay  Dana,  B.  S.,  says :  "A  spine  can  stand  a  ten- 
sion of  750  pounds.  Such  being  true,  it  can  easily  be  shown 
mathematically  that  it  would  only  take  a  blow  with  a  velocity 
of  five  feet  a  second,  given  by  a  man  who  could  put  ten 
pounds  of  his  weight  behind  his  adjustment,  in  order  to  move 
a  vertebra  one-sixteenth  of  an  inch.  This  kind  of  a  blow  is 
obviously  within  the  capacity  of  any  average  man." 

From  all  the  foregoing  it  is  evident  that  chiropractic  does 
not  deal  with  the  effects  of  a  disease  process.  It  does  not 
guess,  surmise,  or  theorize.  It  recognizes  the  true  and  pri- 
mary cause  of  many  diseases  and  relieves  that  cause.  It  is 
founded  on  anatomical  and  physiological  facts.  Its  action 
is  specific,  scientific,  and  unfailing. 


CHAPTER  III 

The  Anatomical  Basis  of  Chiropractic 

Probably  the  chief  reason  why  so  many  have  thus  far 
decHned  to  accept  vertebral  subluxations  as  a  possible  factor 
in  the  production  of  disease  is  because  of  the  opinions  of  the 
anatomists  of  a  centuryago,  and  of  many  who  have  followed 
in  their  wake.  These  anatomists  have  continually  taught 
that  while  a  certain  amount  of  motion  between  individual 
vertebrae  is  possible,  a  displacement  of  a  vertebra  is  impossible. 

There  are  three  chief  reasons  for  this  opinion  having  been 
formed  and  adhered  to:  (1)  The  main  reason  why  displace- 
ments of  the  vertebrae  have  thus  far  been  considered  as  being 
impossible  is  the  fact  that  they  are  surrounded  and  held  in 
position  by  numerous  ligaments,  the  natural  tendency  of 
which  is  to  bind  the  individual  vertebrae  so  firmly  in  place 
that  any  movement  beyond  that  necessary  for  normal  move- 
ments of  the  spine  should  be  impossible  without  fracture. 
(2)  It  has  been  considered  impossible  for  vertebral  subluxa- 
tions to  exist  on  account  of  the  configuration  of  the  surfaces 
of  the  articular  processes  in  relation  to  each  other.  (3)  Fail- 
ure to  discriminate  between  a  subluxation  and  a  dislocation 
has  been  an  important  factor  in  the  want  of  recognition  of 
the  possibility  of  subluxation  of  the  vertebrae. 

We  will  now  consider  each  of  these  points,  and  show 
wherein  they  fail  to  disprove  the  possibility  of  subluxation 
of  the  vertebrae. 

Some  works  on  anatomy  make  the  statement  that  if  a  team 
of  oxen  were  placed  at  one  end  of  a  spinal  column,  and  an- 
other team  at  the  other  end,  both  pulling  in  the  opposite  direc- 
tion, separation  of  the  vertebrae  would  not  occur.  This  may 
be  perfectly  true  but  it  would  not  prove  that  displacement 
of  the  vertebrae  could  not  be  produced  by  forces  applied  in 
other  directions  than  tension.  The  spine  "can  withstand  tre- 
mendous stresses  perfectly."  Considering  the  spine  in  tension, 
we  know  that  a  child  can  be  lifted  by  the  head  and  suffer  no 

15 


16  SPINAL  ADJUSTMENT 

injury;  the  spines  of  aerial  acrobats  are  constantly  in  tension 
and  they  have  perfect  co-ordinative  control,  are  constantly 
swinging  by  the  hands,  feet,  knees,  or  teeth,  and  supporting 
one  or  two  of  their  fellows.  Stretching  machines  have  shown 
that  750  pounds  can  be  maintained  with  benefit  (Dana). 
But  tension,  and  compression,  which  is  the  opposite  to  ten- 
sion, are  two  very  different  things.  Tension  tends  to  increase 
the  calibre  of  the  intervertebral  foramina,  in  fact  actually  does 
so,  for  it  can  be  demonstrated  that  following  tension  of  the 
spine  it  is  longer  than  before.  Compression,  on  the  contrary, 
diminishes  the  calibre  of  the  intervertebral  foramina  by  lessen- 
ing the  length  of  the  spine  as  a  whole.  Whether  the  vertebrae 
can  be  moved  apart  or  not  makes  very  little  difference,  there- 
fore, from  a  clinical  standpoint.  And,  further,  as  will  be 
shown  later  on,  experiments  on  the  dead  spine  are  no  criterion 
by  which  to  draw  conclusions  regarding  the  living  spine. 
The  conclusion  drawn  from  the  fact  that  tension  of  the  spine 
does  not  produce  displacement  of  the  vertebrae  are  erroneous, 
for  the  reason  that  simply  because  a  vertebra  cannot  be  dis- 
placed by  that  means,  it  does  not  follow  that  displacements 
may  not  occur  in  other  directions,  or  be  produced  by  other 
means. 

The  great  strength  of  the  ligaments  surrounding  the  verte- 
brae is  adduced  as  a  reason  for  the  impossibility  of  subluxa- 
tions taking  place.  Superficially  considered,  this  view  seems 
plausible,  for  we  know  that  the  vertebrae  really  are  surrounded 
by  many  powerful  ligaments,  which,  all  conditions  being  equal, 
should  prevent  any  displacement  of  the  vertebrae.  But  just 
here  this  theory  disproves  itself,  for  conditions  are  not  always 
equal.  Were  the  ligaments  unyielding,  inanimate  bands, 
never  changing,  and  always  of  the  same  degree  of  contraction 
on  each  side  of  the  vertebral  column,  any  displacement  of  the 
vertebrae  sufficient  to  produce  serious  consequences  would  be 
impossible.  But  these  ligaments  are  vital  structures,  con- 
stantly changing,  now  contracted  and  again  relaxed.  At  times 
the  ligaments  on  one  side  are  more  contracted  than  those  of 
the  opposite  side,  as  a  result  of  external  or  reflex  irritation. 
As  examples  of  the  production  of  contraction  of  muscles  by 
irritation  the  following  may  be  cited :  Cold  air  striking  the 
surface  of  the  body  causes  the  tiny  muscles  surrounding  the 


ANATOMICAL  BASIS  OF  CHIROPRAC  TIC  17 

pores  of  the  skin  to  contract.  Striking  the  biceps  muscle  a 
quick  blow  and  noting  the  local  contraction  at  the  exact  spot 
struck  also  illustrates  the  production  of  muscular  contraction 
by  irritation.  These  are  both  examples  of  external  irritation. 
As  an  example  of  reflex  irritation  acting  to  produce  muscular 
contraction,  the  spasmodic  contraction  of  the  musculature  of 
the  intestine  produced  by  the  presence  of  gas  may  be  noted. 

These  same  principles  may  be  applied  to  the  muscles  and 
ligaments  of  the  spine,  and  will  be  fully  discussed  in  the 
section  dealing  with  vertebral  malalignment. 

It  was  stated  above  that  the  ligaments  of  one  side  of  the 
spine  may  at  times  be  more  contracted  than  those  of  the 
other  side.  This  would  naturally  tend  to  draw  the  vertebra 
with  which  these  ligaments  are  connected  toward  the  side  on 
which  the  contracted  condition  of  the  ligaments  exists.  Were 
the  ligaments  of  each  side  equally  contracted,  there  would  be 
a  perfectly  balanced  condition  and  displacements  of  the  verte- 
brae would  be  impossible.  It  is  because  of  this  lack  of  bal- 
ance that  subluxations  may  be  produced,  and  it  is  this 
contingency  which  anatomists  have  failed  to  take  into 
consideration. 

The  musculature  of  each  segment  of  the  spinal  column  is 
supplied  by  outgoing  nerve-fibres  in  the  posterior  division  of 
the  corresponding  spinal  nerve.  In  a  reflex  act  the  outgoing 
impulse  passes  to  this  branch  of  the  spinal  nerve.  \\'hen  the 
stimulus  at  the  periphery  which  excites  the  reflex  act  is  applied 
on  one  side  of  the  median  plane,  the  responses  first  appear  in 
the  muscles  of  the  same  side ;  and  if  the  stimulus  is  slight, 
they  may  appear  on  that  side  only.  The  incoming  impulses 
are  therefore  first  and  most  eft'ectively  distributed  to  the 
efferent  cells  located  on  the  same  side  of  the  cord  as  that 
on  which  these  impulses  enter.  In  the  peripheral  system  the 
nerve-impulse,  when  once  started  within  a  fibre  or  axone,  is 
confined  to  that  track  and  does  not  diffuse  to  other  fibres 
running  parallel  with  it,  but  if  does  extend  to  all  the  branches 
of  that  axone,  zvhate^t'er  their  distribution.  As  a  result  of 
this  physiological  fact,  the  first  response  to  the  outgoing  im- 
pulse of  a  reflex  act  will  be  a  contraction  of  the  muscles  and 
ligaments  of  the  spine  on  the  side  at  wdiich  the  ingoing  im- 
pulse  entered   the   cord,    since   these   muscles   and   ligaments 


18  SPINAL  ADJUSTMENT 

are  supplied  by  the  efferent  fibres  in  the  posterior  division  of 
the  spinal  nerve,  which  is  the  first  branch  given  off  from  the 
spinal  nerve. 

Physiologically,  a  muscle  that  is  repeatedly  stimulated  by 
nerve-impulses  finally  reaches  a  state  of  tetanic  contraction, 
that  is  to  say,  if  the  impulses  are  continuous,  the  muscle 
finally  remains  in  a  permanently  contracted  condition.  We 
know  that  the  act  of  defecation  is  reflexly  produced  as  a  re- 
sult of  efferent  nerve-impulses  to  the  muscles  of  the  bowel. 
These  efferent  impulses  are  first  excited  in  the  cord  in  re- 
sponse to  afferent  impulses  from  the  bowel,  produced  by 
stimulation  of  the  nerve-endings  in  its  walls  by  the  presence 
of  feces.  Since  the  efferent  impulses  extend  to  all  the  branches 
of  the  efferent  nerve,  each  such  outgoing  impulse  also  pro- 
duces a  slight  contraction  of  the  muscle  in  that  segment  of 
the  spine,  and  on  the  same  side  on  which  the  ingoing  impulses 
entered. 

If  instead  of  the  mild  normal  afferent  impulses  there  should 
be  continuous  strong  impulses,  as  a  result,  for  example,  of  an 
inflammatory  condition  of  the  intestine,  there  will  be  a  con- 
tinuous flow  of  efferent  impulses  and  the  mild  contractions 
of  the  muscles  and  ligaments  of  the  spine  will  be  replaced  by 
continuous  contractions. 

In  like  manner  there  are  numerous  ways  in  which  different 
spinal  segments  are  affected,  depending  on  the  origin  of  the 
afferent  impulses.  We  thus  see  that  reflex  action  is  constantly 
going  on,  and  that,  therefore,  the  musculature  of  different 
spinal  segments  is  seldom  if  ever  in  a  state  of  balanced  con- 
traction on  each  side.  If  this  contraction  on  the  one  side  is 
continuous,  the  corresponding  vertebra  must  inevitably  be 
drawn  toward  that  side.  We  find,  therefore,  that  although 
the  ligaments  of  the  spine  are  strong  enough  to  hold  the  verte- 
brae in  proper  position,  if  the  potential  strength  of  one  side  be 
increased  by  contraction  of  the  ligaments  the  vertebra  will  be 
drawn  to  that  side. 

As  to  the  second  of  the  reasons  adduced  for  the  impossi- 
bility of  subluxation  of  the  vertebrae,  namely,  the  configura- 
tion of  the  articular  processes,  this  opinion  is  based  on  com- 
parison with  animals  and  a  study  of  the  surfaces  of  the 
articular  processes  in  the  human  spine. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  19 

Studied  from  a  purely  mechanical  viewpoint,  the  error 
in  these  conclusions  becomes  at  once  apparent.  First  of  all, 
not  only  are  the  articular  processes  of  quadrupeds  constructed 
differently  from  those  in  man,  they  are  also  placed  in  a  differ- 
ent plane ;  that  is  to  say,  they  are  placed  in  a  horizontal 
position  in  animals,  while  in  man  they  are  in  a  vertical 
position. 

Let  us  take  for  example  the  dorsal  vertebrae.  By  study- 
ing a  group  of  these  vertebrae,  it  may  be  seen  at  a  glance  how 
comparatively  impossible  it  would  be  for  a  subluxation  to 
occur  there  while  the  body  is  in  the  horizontal  position,  and 
how  easily  possible  it  is  for  the  subluxation  to  occur  with  the 
body  in  the  vertical  position. 

The  human  spine  has  been  compared  with  that  of  a  cat 
to  show  that  subluxations  are  impossible  owing  to  the  shape 
and  placement  of  the  articular  processes.  The  human  spine 
and  that  of  the  cat  are,  however,  very  different.  In  the  cat, 
the  articulations  between  the  vertebrae  permit  of  the  greatest 
flexibility,  there  is  great  freedom  of  movement,  not  alone  of 
the  spine  as  a  whole,  but  also  of  the  individual  vertebrae  with 
each  other.  In  man,  on  the  contrary,  while  the  spine  as  a 
whole  is  comparatively  flexible,  movement  between  any  two 
vertebrae  is  very  much  restricted.  As  a  result  of  this  differ- 
ence in  the  mobility  of  one  vertebra  upon  the  other,  it  is  evi- 
dent that,  when  a  slight  displacement  of  one  vertebra  upon 
another  is  brought  about  in  a  cat,  it  is  at  once  rectified,  while 
in  man  it  tends  to  persist. 

Many  diseases  and  conditions  peculiar  to  the  human  be- 
ing have  been  proven  beyond  doubt  to  be  dependent  upon 
the  vertical  position  assumed  during  his  waking  hours.  These 
conditions  are  analogous  to  those  which  occur,  for  the  same 
reason,  in  the  spine.  Thus  we  may  consider,  for  example, 
hemorrhoids ;  it  is  well  known  that  the  hemorrhoidal  veins 
in  the  lower  rectum  have  no  valves,  as  have  the  veins  of  the 
extremities ;  it  was  simply  because  these  veins  were  originally 
designed  by  nature  with  a  horizontal  position  in  view.  Natu- 
rally, in  this  position  the  return  flow  of  the  blood  to  the  heart 
would  readily  occur,  which  is  not  true  of  the  veins  in  the 
vertical  position,  and  consequently  no  valves  would  be  re- 
quired there.     Owing  to  the  fact,  however,  that  during  so 


20 


SPINAL  ADJUSTMENT 


Fig.  1. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  21 

many  of  our  waking  hours  we  are  in  a  vertical  position,  the 
blood  tends  to  gravitate  toward  the  most  dependent  portions, 
with  the  result  that  the  hemorrhoidal  veins  become  pouched 
and  dilated,  which  condition  is  known  as  hemorrhoids. 

Another  illustration  of  the  anatomical  basis  of  abnormal 
conditions  which  is  a  counterpart  of  the  anatomical  basis  of 
the  production  of  vertebral  subluxations  are  uterine  disorders, 
especially  malpositions.  A  study  of  the  arrangement  and 
points  of  attachment  of  the  uterine  ligaments,  which  exist  for 
the  purpose  of  holding  the  uterus  in  position,  shows  that  these 
ligaments  subserve  their  purpose  best  when  the  body  is  in 
the  horizontal  position.  In  proof  of  this  fact,  note  how  quickly 
retroversion  of  the  uterus  is  rectified  by  having  the  patient 
assume  the  knee-chest  position  for  a  half-hour  each  day.  It 
is  because  the  uterine  ligaments  hold  the  uterus  in  the  vertical 
position  for  which  they  are  not  designed  that  anteflexion  is  so 
common  in  girls.  It  is  also  on  account  of  the  likelihood  of 
weakening  of  the  ligaments  during  pregnancy  that  retrover- 
sion follows  childbirth.  Lastly  it  is  for  this  reason  that  opera- 
tions upon  the  uterine  ligaments  for  the  correction  of  uterine 
displacements  are  so  uniformly  unsuccessful. 

If  the  above  hypothesis,  namely  that  the  vertical  posi- 
tion is  responsible,  on  account  of  the  anatomical  construction 
of  those  parts,  for  the  production  of  hemorrhoids  and  uterine 
malpositions  is  true,  it  can  be  with  equal  reason  applied  to 
the  vertebral  column,  since  a  study  of  its  construction  from 
a  mechanical  viewpoint  shows  clearly  that  it  is  originally  de- 
signed for  a  horizontal  position  and  not  for  the  vertical. 
Consequently,  when  the  vertebral  column  is  placed  in  the  ver- 
tical position — when  a  "beam"  becomes  a  "column" — slight 
separation  of  its  component  parts  is  likely  to  occur. 

It  may  be  questioned  by  some :  If  the  spine  is  constructed 
for  the  horizontal  position,  what  is  the  need  of  the  interverte- 
bral cartilaginous  discs,  which  are  considered  to  exist  for  the 
purpose  of  preventing  jars  to  the  vertebral  column?  Further- 
more if  they  were  formed  since  the  spine  has  assumed  an  up- 
right position,  why  have  not  the  articular  processes  also  had 
time  to  change  to  meet  the  changed  requirements  put  upon 
them?  This  can  be  answered  very  readily,  by  calling  atten- 
tion to  the  fact  that  the  discs  are  far  from  being  merely  for  the 


22 


SPINAL  ADJUSTMENT 


Fig.  2. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  23 

purpose  of  preventing  jarring  of  the  spinal  column.  Their 
important  function  is  this :  Were  there  no  cartilage  interposed 
between  the  bodies  of  the  vertebrae,  the  slight  movement  be- 
tween the  bare  bone  would  soon  cause  the  bones  to  wear 
away.  It  has  its  counterpart  in  all  joints  (and  the  vertebral 
articulations  are  joints)  which  are  lined  with  cartilage. 

In  this  connection,  let  us  quote  a  few  extracts  from  an 
article  on  this  subject  by  an  engineer,  William  Jay  Dana,  B.  S. 
"The  spine  is  used  as  a  column,  while  it  is  designed  to  serve 
as  a  beam.  As  a  column  it  is  far  from  ideally  efficient,  is 
made  up  of  twenty-four  vertebrae  held  together  by  ligaments, 
muscles,  etc.,  and  separated  by  cartilaginous  pads,  which  are 
easily  compressed.  When  a  spinal  column  is  suspended  hori- 
zontally all  the  vertebrae  lock  with  one  another,  the  zygapo- 
physes  being  in  perfect  articulation.  When  held  vertically  the 
vertebrae  tend  to  collapse  and  to  form  imperfect  articulations, 
as  there  are  no  osseous  checks — nor  ligaments  strong  enough 
to  keep  the  spine  in  perfect  alignment  when  vertical ;  moreover 
the  loading  on  the  column  is  eccentric,  the  center  of  gravity 
of  head  and  thorax  is  outside  the  center  line  of  the  column ; 
this  means  the  vertical  column  always  has  a  load  on  it  tending 
to  pull  it  downward ;  to  overcome  this  there  are  powerful 
muscles  along  the  back.  The  result  is  the  column  becomes 
curved  at  two  points  to  compensate  for  the  eccentric  load  it 
has  to  support.  These  curves  due  to  deflection  are  parabolic. 
Loads  carried  upon  the  head  produce  peculiar  types  of  back, 
resulting  in  curvatures,  cretinism,  thyroidism,  and  similar  dis- 
eases which  previously  had  not  a  satisfactory  etiology.  The 
cervicals,  being  the  weakest,  give  way  first ;  hence  we  see  the 
thyroid  type  in  European  mountainous  districts,  where  drink- 
ing water  has  been  erroneously  accused  of  causing  cretinism, 
etc.  The  lower  cervical  vertebrae  become  subluxated,  so  that 
adjustments  here  relieve  thyroid  troubles.  Any  muscular  con- 
tractions approximate  the  vertebrae  or  pull  them  out  of  line 
if  daily  persisted  in ;  hence,  occupational  diseases.  Every  mo- 
tion causes  a  pose  or  attitude ;  a  persistence  of  attitude  causes 
a  subluxation  or  a  tendency  thereto. 

"Besides  tension  and  compression  there  are  two  other 
forces  acting  through  the  spine,  namely  shearing  (slipping) 
and    torsion    (turning).      The    whole    argument    rests    upon 


24 


SPINAL  ADJUSTMENT 


Fig.  3. 


ANATO.MICAL  BASIS  OF  CHIROPRACTIC  25 

whether  the  vertebrae  can  slip  or  sHde  in  respect  to  one  an- 
other. We  know  that  in  turning  the  head  and  trunk  with 
respect  to  the  hips,  that  the  vertebrae  twist  slightly  in  respect 
to  their  fellows.  Question :  Can  a  condition  occur  in  which 
twisting  is  so  great  as  to  cause  pressure  on  the  spinal  nerves 
which  pass  through  the  lateral  openings?  Dissection  of  spinal 
vertebrae  shows  such  pressure  does  take  place  with  conse- 
quent atrophy  or  degeneration." 

The  next  question  that  naturally  arises  is :  Assuming  that 
vertebral  subluxations  may  occur,  does  enough  displacement 
occur  to  produce  pressure  upon  the  structures  passing  through 
the  intervertebral  foramina  ?  This  question  has  been  answered 
at  length  in  the  preceding  chapter,  and  leaves  little  to  be  said. 
It  must  be  remembered  that  it  requires  very  little  pressure 
upon  a  nerve  to  destroy  its  power  of  conductivity,  and  that  is 
all  that  is  required  to  disturb  the  function  of  the  parts  which 
that  ner^e  supplies. 

That  nature  recognizes  the  tremendous  importance  of 
maintaining  the  normal  calibre  of  the  intervertebral  foramina 
she  demonstrates  in  numerous  ways.  For  example,  examina- 
tion of  spines  in  osteological  collections  of  the  National  School 
of  Chiropractic  shows  how  the  exostoses,  where  present,  are 
so  arranged  that  they  protect  the  intervertebral  foramen  from 
becoming  completely  occluded,  as  the  vertebrae  collapse. 
Again,  in  old  age,  when  settling  of  the  spine  occurs,  and  there 
comes  the  danger  of  complete  closure  of  the  intervertebral 
foramina,  nature  recognizes  this  danger,  and  the  spine  be- 
comes bent  forward,  and  the  back  parts  of  the  vertebrae  are 
thrown  apart  to  prevent  this  contingency. 

Comparison  of  the  eftect  of  pressure  of  the  margins  of  the 
intervertebral  foramen  upon  a  nerve  has  been  made  to  the 
shutting  ofif  of -the  flow  of  water  through  a  hose,  to  the  stop- 
ping of  the  current  of  electricity  in  a  wire,  and  to  many  other 
similar  examples.  Such  examples  are  misleading,  and  prove 
nothing  because  the  exact  nature  of  the  conduction  process  is 
not  understood  and  bears  no  similarity  to  the  examples  noted. 
All  that  is  positively  known  is  that  pressure  upon  a  nerve  will 
prevent  conduction  of  impulses  by  it,  and  that  sufificient  pres- 
sure to  produce  this  effect  may  be  exercised  by  the  margins  of 
the  intervertebral  foramina  when  a  vertebra  is  subluxated. 


26 


SPINAL  ADJUSTMENT 


Fig.  4, 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  27 

It  is  a  strange  fact  that  medical  students  are  required  to 
make  a  minute  dissection  of  the  peripheral  nervous  system  to 
the  minutest  branches  of  the  nerves,  but  a  dissection  of  the 
spine  is  not  required.  Probably  if  such  had  been  required, 
much  that  at  the  present  time  seems  to  the  average  medical 
man  as  mysterious  would  long  ago  have  been  made  clear.  It 
has  remained  for  the  students  of  spinal  adjustment  to  do  this, 
and  the  spinal  findings,  post  mortem,  reveal  the  truth  of  the 
existence  of  displacements  of  the  vertebrae.  The  figures 
shown  on  the  following  pages  are  reproductions  of  photo- 
graphs taken  of  a  cadaver  in  process  of  dissection  in  the  an- 
atomical laboratory  of  the  National  School  of  Chiropractic  of 
Chicago,  by  the  author,  with  the  assistance  of  Dr.  Erik  Juhl. 
These  illustrations  show  several  important  things :  first,  that 
subluxations  really  exist;  second,  that  sufificient  displacement 
of  the  vertebrae  is  present  to  occasion  pressure  upon  the  struc- 
tures passing  through  the  intervertebral  foramina ;  and,  third, 
that  these  subluxations  may  be  detected  by  palpation  of  the 
surface  of  the  back. 

In  reading  articles  in  medical  journals  dealing  with  the 
etiology  of  various  diseases  and  conditions  one  is  often  struck 
with  the  fact  that  statements  made  imply  that  a  spinal  lesion 
must  be  the  basis,  yet  the  simple  statement  to  that  efifect  is 
never  made.  Numerous  quotations  might  be  given  in  which 
it  could  be  shown  that  the  etiological  factors  given  by  the 
authors  of  those  articles  are  but  another  name  for  subluxation 
of  the  vertebrae.  These  writers  realize  that  improper  innerva- 
tion is  the  basis  for  many  conditions,  yet  fail  to  find  the  key 
to  the  mode  of  production  of  the  faulty  innervation,  namely 
pressure  upon  the  spinal  nerves  by  the  displaced  margins  of 
the  lateral  foramina  through  which  they  pass. 

A  careful  study  of  these  illustrations  reveals  the  interest- 
ing fact  that  the  subluxated  vertebrae  as  indicated  on  the 
integument  in  Fig.  1  are  shown  with  the  various  layers  of  the 
muscles  of  the  back  removed.  In  succeeding  reproductions 
the  abnormal  position  of  the  spinous  processes  becomes  gradu- 
ally more  and  more  distinct.  Finally  the  narrowed  interver- 
tebral foramina  are  seen  corresponding  to  the  seat  of  some  of 
the  spinal  lesions. 

These  figures  prove  beyond  any  successful  denial  that  dis- 


28 


SPINAL  ADJUSTMENT 


Fig.  5. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  29 

placements  of  the  vertebrae,  without  fracture,  are  not  only 
possible  but  actually  do  exist.  These  photographic  repro- 
ductions, while  showing  the  actual  narrowing  of  the  interver- 
tebral foramina,  cannot  show  the  compression  of  the  vessels 
and  nerves  as  witnessed  directly  on  the  cadaver.  Another  in- 
teresting fact  brought  out  in  the  cadaver  was  the  ease  with 
which  the  handle  of  the  scalpel  could  be  introduced  into  the 
foramina  corresponding  to  vertebrae  which  were  not  sub- 
luxated,  and  the  impossibility  of  introducing  it  into  those 
foramina  whose  component  vertebrae  were  displaced. 

It  might  be  stated  that  there  were  present  at  the  dissection 
of  the  cadaver  which  revealed  these  findings  some  who  had 
more  or  less  misgivings  relative  to  the  actual  existence  of 
vertebral  subluxations.  No  one,  however,  could  deny  the 
truth  of  what  his  eyes  witnessed. 

The  accompanying  illustrations,  being  reproductions  of 
photographs  of  the  spinal  column,  are  as  convincing  as  the 
direct  dissection  of  the  cadaver  was,  and  prove  once  more 
that  subluxation  of  the  vertebrae  is  no  longer  a  theory  but 
a  fact. 

By  palpation  of  the  vertebral  column  of  the  cadaver  the 
■  following  subluxations  were  noted  : 

The  first  cervical  vertebra  was  displaced  laterally  to  the 
right. 

The  fourth  cervical  vertebra  was  displaced  laterally  to  the 
right. 

The  sixth  cervical  vertebra  was  displaced  laterally  to  the 
right. 

The  third  thoracic  vertebra  rotated  upon  its  axis  toward 
the  left. 

The  eighth  thoracic  vertebra  was  rotated  on  its  axis  toward 
the  left. 

The  ninth  thoracic  vertebra  was  rotated  on  its  axis  toward 
the  right. 

The  tenth  thoracic  vertebra  was  displaced  posteriorly. 
The  first  luml)ar  vertebra  was  rotated  on  its  axis  toward 
the  right. 

The  fourth  lumbar  vertebra  was  displaced  posteriorly. 


30 


SPINAL  ADJUSTMENT 


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ANATOMICAL  BASIS  OF  CHIROPRACTIC  31 

The  following  are  the  designations  of  the  subluxations  of 
the  vertebrae  as  outlined  above : 

IC R.  L.       9D    L.  R. 

4C  R.  L.     lOD P. 

6C  R.  L.        IL    L.  R. 

3D    R.  R.       4L   P. 

8D    R.  R. 

Fig.  1  shows  these  various  subluxations  marked  opposite 
the  vertebrae  above  enumerated.  The  marks  correspond  to 
the  position  of  the  spinous  processes  of  the  vertebrae  which 
Avere  subluxated.  Several  other  spinous  processes  were  also 
found  out  of  alignment,  but  palpation  of  the  corresponding 
transverse  processes  revealed  nothing  abnormal  as  to  the 
position  of  the  vertebrae  in  question.  This  was  later  verified 
upon  directly  viewing  the  vertebrae,  when  it  was  noted  that 
the  spinous  processes  merely  deviated  from  their  normal  di- 
rection of  projection  from  the  body  of  the  vertebrae. 

Fig.  2  shows  the  back  with  the  skin  and  superficial  fascia 
removed,  and  the  first  layer  of  muscles  of  the  back  revealed. 
In  this  illustration  the  position  of  the  spinous  processes  is 
somewhat  evident  on  inspection,  and  they  were  readily  palpable. 

Fig.  3  shows  the  back  with  the  first  layer  of  muscles  re- 
moved and  the  second  layer  revealed.  The  spinous  processes 
in  this  figure  are  readily  seen,  and  deviations  from  their 
normal  position  can  be  noted. 

Fig.  4  shows  the  back  with  the  second  layer  of  muscles 
removed,  and  the  third  layer  revealed.  In  this  illustration  the 
transverse  processes  are  also  seen  in  some  segments,  while 
the  spinous  processes  are  very  evident. 

Fig.  5  shows  the  back  with  the  fourth  layer  of  muscles  re- 
moved and  the  fifth  layer  exposed.  The  spinous  and  trans- 
verse processes  can  be  readily  seen. 

Fig.  6  shows  the  back  with  the  fourth  layer  of  muscles 
removed  and  the  fifth  layer  exposed.  The  spinous  processes 
in  this  illustration  are  entirely  uncovered  by  muscles  and  liga- 
ments and  stand  out  very  prominently. 

Fig.  7  shows  the  left  half  of  the  back,  the  right  half  hav- 
ing been  entirely  removed  by  disarticulating  the  ribs  from  the 
vertebrae,    for    the    purpose    of    showing   the    intervertebral 


32 


SPINAL  ADJUSTMENT 


Fig.  7. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  33 

foramina  seen  in  the  following  figure.  This  illustrates  a  pos- 
terior view  of  the  back,  with  all  muscles  and  ligaments  re- 
moved, and  showing  the  vertebrae.  The  lower  ribs  have  been 
disarticulated,  and  the  pleura  is  visible.  This  figure  shows 
very  clearly  the  displacement  of  the  eighth  thoracic  vertebra ; 
note  the  prominence  of  the  transverse  process  on  the  right  side, 
which  shows  that  the  vertebra  is  rotated  toward  the  left;  the 
right  side  of  the  intervertebral  cartilage  was  also  compressed; 
and  the  vertebra  displaced  upward,  as  shown  by  the  fact 
that  the  transverse  processes  of  the  eighth  and  ninth  vertebrae 
are  close  to  each  other.  The  upward  displacement  is  well 
shown  in  the  following  figure. 

Fig.  8  shows  two  intervertebral  foramina  which  are  much 
diminished  in  size,  as  will  be  readily  noted  by  comparing  them 
with  the  other  foramina  shown.  These  foramina  whose  lumen 
is  diminished  correspond  to  the  eighth,  ninth  and  tenth  tho- 
racic segments.  The  eighth  thoracic  vertebra  is  distinctly 
shown  displaced  toward  the  right  side,  which  was  the  side 
of  the  spine  photographed.  Note  how  the  articular  process 
encroaches  upon  the  lumen  of  the  intervertebral  foramen.  This 
figure  shows  the  actual  narrowing  of  an  intervertebral  fora- 
men, by  the  displacement  of  a  vertebra,  and  positively  dispels 
any  doubt  as  to  the  possibility  of  vertebral  subluxations  with- 
out fracture,  and  a  consequent  narrowing  of  the  corresponding 
intervertebral  foramen.  This  narrowing  is  amply  sufficient 
to  produce  enough  pressure  upon  the  vessels  transmitted 
through  the  foramen,  and  of  the  nerves  to  destroy  their  power 
of  conductivity. 

The  following  extracts  from  Dr.  Alfred  Walton's  writings 
along  this  subject  apply  in  this  connection  as  bearing  on  the 
anatomical  basis  of  chiropractic :  "Every  normal  spine  has 
certain  architectural  defects.  The  third  and  fourth  cervical 
vertebrae  are  exceedingly  delicate  in  structure,  and  permit  of 
much  lateral  motion,  whereby  the  head  is  greatly  tilted  to 
one  side,  as  is  seen  in  children  with  hydrocephalus.  The 
sixth,  seventh  and  eighth  dorsal  vertebrae  are  relatively  weak, 
and  are  frequently  subluxated,  which  accounts  for  the 
prevalence  of  dyspepsia,  and  also  for  the  whole  train  of  dis- 
orders incident  to  pressure  upon  the  spinal  nerves  concerned 
with  digestion. 


34 


SPINAL  ADJUSTMENT 


Fig.  8. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  35 

"The  American  people  are  said  to  be  a  nation  of  dyspeptics. 
The  cause  is  frequently  referred  to  as  due  to  improperly  cooked 
foods  and  hurried  eating;  these  are  not  the  principal  factors, 
however,  for  dyspepsia  is  exceedingly  common  with  those 
who  are  confirmed  invalids,  who  eat  slowly,  and  confine  them- 
selves to  a  carefully  selected  diet.  The  fact  is,  that  as  soon 
as  pressure  is  removed  from  the  middle  dorsal  nerves,  the 
dyspeptic  begins  to  take  on  flesh,  and  has  a  digestion  strong 
enough  to  eat  anything  placed  before  him. 

"The  tenth  dorsal  vertebra  because  of  not  being  supported 
by  the  ribs,  permits  of  the  rotation  of  the  body,  a  beautiful 
example  of  which  is  demonstrated  when  the  golf  player  tops 
a  ball.  If  his  drive  has  been  of  sufficient  force,  it  will  be 
noticed  that  the  body  has  described  nearly  three-fourths  of  a 
circle ;  hence  the  frequency  with  which  the  tenth  dorsal 
vertebra  is  found  out  of  alignment.  Its  position  is  an  im- 
portant factor  in  the  functioning  of  the  kidneys;  an  adjust- 
ment of  the  tenth  dorsal  is  followed  by  the  disappearance  of 
a  great  variety  of  diseases,  not  only  diseases  of  the  kidneys, 
but  those  of  a  totally  dissimilar  character,  but  dependent 
upon  uric  acid  conditions  as,  for  example,  rheumatism, 
neuralgia,  eye  troubles,  and  many  forms  of  skin  disease." 

The  third  reason  that  subluxations  are  not  considered  pos- 
sible by  some  investigators  is,  that  they  have,  in  the  first 
place,  not  looked  into  this  subject  thoroughly  enough,  and, 
secondly,  that  they  have  failed  to  discriminate  between  the 
terms  subluxation  and  dislocation,  which  are  entirely  dissimilar. 

It  is  true  that  major  lesions  of  the  spine  have  received 
proper  attention.  But  the  possibility  of  the  existence  of  minor 
injuries  of  the  spine  has  never  been  thoroughly  investigated 
until  the  results  achieved  by  spinal  adjustment  have  made 
it  plain  that  minor  spinal  lesions  are  exceedingly  common, 
and  are  followed  by  the  most  serious  consequences  in  many 
instances.  It  will  be  shown  further  on  in  this  work  that  upon 
a  proper  functioning  of  the  nervous  system  depends  the 
harmonious  relationship  of  all  parts  of  the  body,  as  well  as 
their  functional  activity  and  organic  integrity.  This  being 
true,  the  vertebral  column  becomes  the  most  important  di- 
vision of  the  body.  Yet  it  has  received  less  study  than  any 
other  portion,  at  least  from  a  mechanical  viewpoint,  and  the 


36 


SPINAL  ADJUSTMENT 


Fig.  9. 

(A)  Compression  of  the  anterior  portion  of  the  disc,  causing  the  superior 
vertebra  to  approach  the  inferior,  the  articular  process  of  which  encroaches  on 
the  lateral  foramen  between  them. 

(B)  Posterior  displacement  of  the  vertebra  and  thinning  of  the  disc,  causing 
the  articular  process  of  the  vertebra  below  to  encroach  on  the  intervertebral 
foramen. 

(C)  Compression  of  the  disc  in  its  entirety,  resulting  in  a  diminution  of 
the  vertical  diameter  of  the  intervertebral  foramen. 


ANATOMICAL  BASIS  OF  CHIROPRACTIC  37 

body  should  be  studied  from  that  viewpoint,  since  it  is  in 
reality  a  piece  of  mechanism.  The  location  at  which  inter- 
ference with  nerve  function  is  most  likely  to  occur  is  naturally 
there  where  the  nerves  are  most  subject  to  injury.  Such  a 
location  the  intervertebral  foramina  admirably  furnish,  for 
here  the  nerves  pass  between  movable  bones  which  may  be- 
come displaced  and  subject  the  nerves  to  pressure. 

Ordinarily  when  the  word  subluxation  is  mentioned  the 
reader  at  once  pictures  to  himself  a  disarticulation  of  the 
vertebrae,  and  since  it  really  is  impossible  for  a  complete 
disarticulation  of  a  vertebra  to  occur  without  fracture,  he 
discredits  the  possibility  of  a  subluxation.  This  is,  however, 
the  wrong  construction  of  the  term  since  a  subluxation  is  not 
a  complete  disarticulation  of  a  vertebra  from  the  vertebra 
above  and  below  it.  It  is  simply  a  slight  change  in  the 
relative  position  of  a  vertebra  with  the  contiguous  vertebrae 
above  and  below  it.  That  is  to  say,  instead  of  the  entire  sur- 
face area  of  a  vertebra  being  approximated,  with  die-like  pre- 
cision and  accuracy,  to  its  fellows  above  and  below  it,  it  is 
slightly  moved  from  this  position.  There  is  not  an  absolute 
and  entire  separation  of  the  articular  processes  of  two  ver- 
tebrae ;  on  the  contrary,  the  greater  portion  of  their  surface 
area  still  oppose  each  other;  there  has  simply  been  a  slight 
shifting  of  one  upon  the  other.  This  movement  takes  place 
in  various  directions  depending  upon  the  configuration  of  the 
articular  processes. 

As  was  shown  in  the  preceding  chapter  this  movement 
of  a  vertebra  need  be  very  slight  to  produce  sufficient  pres- 
sure upon  the  structures  passing  through  the  intervertebral 
foramen  to  destroy  their  irritability  and  power  of  conductivity. 

The  accompanying  illustrations  show  clearly  that  sub- 
luxations, or  displacements  of  vertebrae  may  exist  without 
fracture  of  the  vertebrae  taking  place.  Were  the  vertebrae 
absolutely  locked  in  position,  even  the  slightest  movement 
would  be  impossible,  including  the  normal  movements.  But 
the  fact  that  some  movement  between  individual  vertebrae  is 
possible  is  evidence  that  varying  degrees  of  movement  may 
take  place,  depending  upon  the  force  applied.  Anything  that 
is  capable  of  some  movement  is  capable  of  greater  or  less 
movement,  and  we  know  that  the  vertebrae  must  move  upon 


38  SPINAL  ADJUSTMENT 

each  other,  or  there  could  be  no  movement  of  the  spine  as  a 
whole.  When  this  movement  exceeds  certain  definite  limits, 
there  is  present  the  danger  of  inability  of  the  vertebra  to 
return  to  its  normal  position.  In  speaking  of  movement  in 
this  regard  very  slight  movement  is  implied,  since  as  men- 
tioned above,  a  movement  of  one-eighth  of  an  inch  will  occa- 
sion pressure  upon  the  structures  passing  through  the  inter- 
vertebral foramen  sufficient  to  prevent  the  conduction  of  im- 
pulses to  the  parts  for  which  they  are  destined,  with  derange- 
ment in  the  parts  supplied  by  the  involved  nerves. 


CHAPTER  IV 

The  Physiological  Basis  of  Chiropractic 

In  the  preceding  chapter  it  was  shown  that  subluxations 
of  the  vertebrae  can  and  do  occur,  and  that  as  a  result  of  this 
displacement  sufficient  pressure  is  brought  to  bear  upon  the 
nerves  passing  through  the  intervertebral  foramina,  by  the 
displaced  margins  of  the  foramina,  to  seriously  impair  their 
function.  In  this  chapter  we  will  consider  the  manner  in 
which  this  disturbance  of  the  functional  activity  is  brought 
about. 

The  Function  of  the  Nervous  System. — By  virtue  of  its 
continuity  the  nervous  system  puts  into  connection  all  the 
other  systems  of  the  body.  Its  branches  form  pathways  over 
which  nerve-impulses  pass  from  the  brain  to  every  part  of  the 
body,  and  from  the  periphery  to  the  brain.  All  incoming  im- 
pulses must  react  in  the  central  nervous  system.  It  is  a  fact 
of  the  utmost  importance  that  until  the  incoming  impulses 
have  reached  the  brain  and  spinal  cord,  they  do  not  give  rise 
to  the  outgoing  impulses.  It  must  be  remembered  that  nearly 
all  outgoing  impulses  are  generated  as  a  result  of  stimulation 
of  the  cerebral  or  spinal  centres  by  an  incoming  impulse. 
For  example,  the  sight  of  food  excites  an  afferent  impulse  to 
the  brain  which  in  turn  excites  an  efferent  impulse  in  the 
cerebral  centres  which  send  nerve-fibres  to  the  salivary  glands, 
and  a  flow  of  saliva  results.  In  like  manner  every  action  per- 
formed by  any  part  of  the  body  is  produced  as  a  result  of  an 
outgoing  impulse  which  was  generated  in  the  brain  or  spinal 
cord  in  response  to  an  impulse  from  the  periphery. 

By  means  of  the  central  nervous  system  reactions  are 
established  in  parts  of  the  body  not  directly  affected  by  the 
changing  external  conditions.  In  this  way  harmony  between 
the  activities  of  the  various  systems  of  the  body  is  maintained. 
Also  the  body  as  a  whole,  in  relation  to  all  things  outside  it 
and  forming  its  environment,  is  under  the  guidance  of  the 
nervous  system. 

39 


40  SPINAL  ADJUSTMENT 

The  Conduction  Process. — In  order  to  appreciate  properly 
the  effects  of  pressure  upon  the  nerve  we  must  first  look  into 
the  nature  of  the  transmission  of  impulses  along  the  nerves, 
namely  the  conduction  process.  Many  views  have  been  ad- 
vanced as  to  the  nature  of  the  conduction  process  among 
which  are,  that  the  whole  nerve  moves  like  a  bell-rope;  that 
the  nerve  is  a  tube  and  a  biting  acid  flows  through  it;  that 
the  nerve  contains  a  fluid  which  moves  in  waves ;  that  it  con- 
ducts an  electric  current  like  a  wire;  that  it  is  composed  of 
definitely  arranged  electro-motor  molecules  which  exert  an 
electro-dynamic  influence  on  each  other ;  that  it  is  made  up  of 
chemical  particles  each  of  which  excites  its  neighbor;  lastly, 
that  the  molecules  of  the  nerve-substance  undergo  a  form  of 
vibration  like  that  of  light. 

None  of  these  theories  has  been  proven  as  the  only  cor- 
rect one,  and  it  is  likely  that  the  conduction  process  is  simply 
a  property  of  the  living  substance  of  the  cell.  It  is  a  state  of 
activity  which  spreads  like  a  wave  in  all  directions  through 
the  living  substance.  It  is  markedly  changed  by  chemical 
and  physical  influences.  Protoplasmic  continuity  is  absolutely 
essential  to  conduction.  Hence,  as  will  be  shown  further  on, 
any  pressure  upon  the  nerve  which  breaks  this  protoplasmic 
continuity  impedes  the  transmission  of  impulses  along  that 
nerve. 

The  Nerve-impulse. — The  neurones  form  pathways  along 
which  nerve-impulses  travel.  It  is  through  the  power  of  con- 
ductivity possessed  by  the  neurones  that  the  impulses  travel 
along  the  nerves.  The  impulses  which  arrive  at  the  cell- 
body  produce  there  chemical  changes.  These  changes,  when 
they  reach  a  given  volume,  cause  a  nerve-impulse  which 
leaves  the  cell-body  by  way  of  the  axone. 

As  will  be  pointed  out,  the  impulses  travel  either  toward 
the  central  system,  or  from  it.  The  former  class  of  impulses 
are  called  afferent,  and  by  means  of  them  the  proper  relation- 
ship of  all  parts  of  the  body,  individually  and  collectively,  to 
their  environment  is  maintained.  The  latter  class  of  impulses 
are  known  as  efferent,  and  it  is  through  them  that  the  func- 
tional activity  and  organic  integrity  of  every  part  of  the  body 
are  governed  and  maintained. 

The  amount  of  nerve  influence  generated  by  the  brain 


PHYSIOLOGICAL  BASIS  OF  CHIROPRACTIC  41 

must  always  be  commensurate  with  the  amount  of  work  re- 
quired of  the  parts  supplied  by  the  nerves.  This  is  excellently 
illustrated  by  the  following:  We  have  the  power  of  de- 
termining beforehand  the  amount  of  nervous  influence  neces- 
sary for  the  production  of  a  certain  degree  of  movement.  Thus 
when  we  lift  a  vessel,  the  force  which  we  employ  in  lifting  it 
depends  upon  the  idea  which  we  have  formed  of  its  contents, 
when  we  are  not  certain  what  it  contains.  If  it  should,  there- 
fore, contain  something  much  lighter  than  we  had  estimated, 
useless  force  would  be  expended,  and  it  would  be  lifted  with 
exceptional  ease ;  but  if  it  contain  something  much  heavier 
than  we  had  anticipated,  we  would  very  likely  drop  it,  because 
insufificient  force  was  expended  to  accomplish  the  end  de- 
sired. 

Just  as  the  response  of  muscles  is  proportionate  to  the 
amount  of  nerve-force  received  by  them,  so  also  are  the 
functional  activities  of  all  parts  of  the  body  dependent  on  the 
amount  or  strength  of  the  nerve-impulses  received  by  them. 
If,  therefore,  anything  interferes  with  the  power  of  conduc- 
tion of  the  nerve,  the  impulses  which  it  normally  conveys  to 
the  parts  which  it  supplies  are  not  forthcoming,  and  these 
parts  will  suffer.  There  will  be  either  functional  derange- 
ment, or  changes  in  its  structure. 

Irritability  of  Nerves. — Irritability  is  that  property  of  liv- 
ing protoplasm  which  causes  it  to  undergo  characteristic 
physical  and  chemical  changes  when  it  is  subjected  to  cer- 
tain influences,  called  irritants.  The  term  irritants,  when 
speaking  of  nerves  includes  anything  which  causes  the  nerve- 
cell  to  send  an  impulse  along  its  branches.  The  irritability 
of  cell-protoplasm  is  very  dependent  upon  its  physical  and 
chemical  constitution,  and  even  slight  alterations  of  this  con- 
stitution, such  as  may  be  induced  by  mechanical  conditions, 
may  modify  the  finely-adjusted  molecular  structure  upon 
which  the  normal  response  to  irritants  depends. 

Without  going  into  this  subject  in  detail,  the  fact  must  be 
stated  that,  when  a  nerve  is  experimentally  subjected  to  slight 
pressure,  it  is  found  that  it  will  not  conduct  impulses ;  when 
the  pressure  is  removed,  it  again  conducts  the  impulses.  A 
frog  in  which  the  sciatic  nerve  and  gastrocnemius  muscle 
are  dissected  and  prepared,  and  then  connected  with  an  elec- 


42  SPINAL  ADJUSTMENT 

trie  current,  will  show  this.  When  the  nerve  is  stimulated 
by  the  current,  contractions  of  the  muscle  occur;  when  pres- 
sure is  brought  to  bear  upon  the  nerve,  the  muscular  con- 
tractions cease ;  when  the  pressure  is  removed  and  the  nerve 
again  electrically  excited,  the  contractions  of  the  muscle  again 
occur.  This  proves  conclusively  that  the  pressure  which  was 
applied  prevented  the  conduction  of  the  impulses,  for  it  is 
the  nervous  impulses  that  caused  the  muscle  to  contract.  It 
also  shows  and  demonstrates  another  important  fact,  namely, 
that  sufficient  pressure  may  be  applied  to  a  nerve  to  prevent 
it  from  conducting  impulses  without  destroying  the  nerve 
itself,  because,  in  the  experiments  mentioned,  as  soon  as  the 
pressure  was  removed,  the  muscular  contractions  again  oc- 
curred. 

The  Effect  of  Pressure  upon  a  Nerve. — In  a  future  chapter 
the  effects  of  vertebral  subluxations  are  given  in  detail,  but 
the  physiological  efTect  of  pressure  on  nerves  in  general  must 
be  considered  at  this  time. 

The  effect  of  pressure  to  lessen  the  conduction  power  of 
nerves  is  one  which  everyone  may  demonstrate  upon  himself. 
For  example,  if  pressure  be  brought  to  bear  on  the  ulnar 
nerve  where  it  crosses  the  elbow,  the  region  supplied  by  the 
nerve  becomes  numb,  "goes  to  sleep,"  as  it  were. 

In  like  manner,  mechanical  applications  to  nerves  first 
increase  and  later  destroy  their  irritability.  Thus  pressure 
gradually  applied  first  increases  and  later  reduces  the  power 
to  respond  to  irritants. 

As  stated  above,  sufficient  pressure  may  be  applied  to  a 
nerve  to  destroy  its  irritability  and  conductivity  without  in- 
juring the  nerve  itself  structurally.  Such  pressure  is  exer- 
cised upon  the  nerves  passing  through  the  intervertebral  for- 
amina by  the  displaced  margins  of  the  foramen  when  a  ver- 
tebra is  subluxated.  The  pressure  does  not  crush  or  otherwise 
injure  the  nerve,  but  it  is  sufficient  to  block  the  impulses 
which  pass  along  that  nerve.  As  a  result,  the  organs  which 
are  deprived  of  these  impulses  undergo  functional  or  organic 
aberrations,  and  disease  results  in  the  part  supplied.  The 
nature  of  the  disease  depends  upon  other  contributory  factors 
which  may  be  present  at  the  time  of  the  subluxation,  or  may 
appear  later.     In  any  event  the  subluxation,  by  promoting 


PHYSIOLOGICAL  BASIS  OF  CHIROPRACTIC  43 

conditions  in  the  organ  which  make  disease  possible  in  that 
organ,  are  the  primary  cause  of  that  disease. 

For  example,  a  subluxation  is  produced  in  the  lower  dorsal 
or  upper  lumbar  region  of  the  vertebral  column ;  no  untoward 
effects  may  follow  at  once.  But  years  later,  perhaps,  the  in- 
dividual develops  typhoid  fever.  The  reason  that  this  occurs 
is  simply  that  the  intestines  which  are  the  atrium  of  the  in- 
fection in  this  disease  are  in  such  a  state  of  diminished  re- 
sistance that  they  form  a  favorable  culture-medium  for  the 
multiplication  of  the  typhoid  bacilli  and  the  elaboration  of 
their  toxins.  It  is  for  this  reason  that  the  fever  subsides  so 
rapidly  when  these  subluxations  are  corrected — because  the 
elaboration  of  the  toxins,  which  are  the  cause  of  the  fever, 
is  arrested,  favorable  conditions  for  the  activity  of  the  bacilli 
having  been  eliminated. 

The  Effect  of  Blood-supply  on  Nerves. — In  addition  to  the 
direct  effect  of  pressure  upon  the  nerves,  owing  to  a  subluxa- 
tion, there  is  also  an  indirect  effect,  as  a  result  of  the  occlusion 
of  the  blood-vessels  which  pass  through  the  intervertebral 
foramen. 

The  nerve-fibre  requires  a  constant  supply  of  blood  for 
the  maintenance  of  its  irritability.  The  irritability  of  the 
nerve  cannot  long  continue  without  oxygen,  and  a  nerve  which 
has  been  removed  from  the  body  is  found  to  remain  irritable 
longer  in  oxygen  than  in  air,  and  in  air  than  in  an  atmosphere 
which  contains  no  oxygen. 

It  will  be  learned  further  on  that  one  of  the  effects  of 
a  subluxation  is  pressure  upon  the  arteries  and  veins.  These 
arteries  supply  the  structures  of  the  corresponding  segment 
of  the  spine  with  nourishment,  and  the  veins  carry  away  the 
waste  materials.  When  the  circulation  of  the  blood  is  im- 
peded, there  will  consequently  be  an  impoverishment  of  the 
nerves,  and  an  accumulation  of  waste  materials,  both  of  which 
have  a  deleterious  effect  on  the  nerves. 

Another  function  of  the  blood  in  respect  to  the  nerves 
is  that  it  distributes  heat.  A  nerve  which  is  deprived  of  this 
heat  loses  its  power  of  irritability  and  conductivity.  This 
can  be  demonstrated  by  dipping  the  elbow  in  ice-water,  and 
allowing  it  to  remain  there  until  the  cold  has  had  time  to 
penetrate ;  at  first  there  will  be  pain,  but  as  the  effect  of  the 


44  SPINAL  ADJUSTMENT 

cold  becomes  greater,  the  pain  is  replaced  by  numbness, 
both  the  irritability  and  power  of  conduction  of  the  nerve 
being  reduced. 

In  like  manner  obstruction  of  the  arteries  passing  through 
the  intervertebral  foramina,  by  pressure  upon  them  of  the 
displaced  margins  of  the  foramen,  diminish  the  blood-supply 
to  the  nerves,  and  hence  the  heat  which  the  blood  normally 
conveys  to  them.  Impulses  to  be  transmitted  by  that  nerve 
will  accordingly  be  impeded,  or  fail  to  reach  their  destination, 
and  disorders  in  the  parts  thus  deprived  of  their  necessary 
nerve-control  will  follow. 

Further,  the  blood  has  the  power  to  neutralize  the  acids 
which  are  produced  by  the  cells  during  action,  and  so  main- 
tain the  alkalinity  essential  to  the  life  and  activity  of  the 
cell;  also,  by  virtue  of  the  salts  which  it  contains  it  secures 
the  osmotic  relations  which  are  necessary  to  the  preserva- 
tion of  the  normal  chemical  constitution  of  the  protoplasm 
of  the  nerve. 

The  irritability  of  nerve  protoplasm  is  markedly  influenced 
by  even  slight  changes  in  its  constitution.  If,  experimentally, 
a  nerve  be  allowed  to  lie  in  a  liquid  of  a  different  composition 
from  its  own  fluid,  and  especially  if  such  a  liquid  be  injected 
into  its  blood-vessels,  an  interchange  of  materials  takes  place 
which  results  in  an  alteration  of  the  tissue  and  a  change  of  its 
irritability. 

If,  therefore,  the  venous  flow  is  obstructed,  the  acid  waste 
materials  of  the  activities  of  nerves  remain  within  them,  and 
a  change  in  the  constitution  of  their  protoplasm  impairs  their 
irritability  and  conductivity.  This  effect  the  pressure  of  the 
displaced  margins  of  an  intervertebral  foramen  produces  by 
obstructing  the  circulation  of  the  blood  in  the  veins  which 
it  transmits. 

The  Effects  of  Lymphatics  on  Nerves. — The  last  of  the 
physiological  effects  resulting  from  a  subluxation  of  a  verte- 
bra with  consequent  narrowing  of  the  corresponding  inter- 
vertebral foramen  is  the  influence  which  it  exercises  upon 
the  lymphatics,  and  their  effect  on  the  nerves  which  they 
supply. 

The  lymphatics  which  pass  through  the  intervertebral 
foramina  have  much  to  do  with  the  metabolism  of  each  seg- 


PHYSIOLOGICAL  BASIS  OF  CHIROPRACTIC  45 

ment  of  the  spinal  cord.  If  the  nutrition  of  a  certain  segment 
is  faulty  as  a  result  of  an  insufficient  supply  of  lymph,  the 
reflex  excitability  of  that  segment  will  be  diminished.  Con- 
sequently any  incoming  impulses  to  that  segment  will  not 
result  in  a  reflex  action  with  the  production  of  an  outgoing 
impulse,  and  the  tissues  thus  deprived  of  these  necessary 
impulses  will  fail  to  function  properly. 

Such  a  condition  of  hypo-excitability  is  always  produced 
by  a  vertebral  subluxation.  In  such  an  event  the  lymphatic 
flow  is  obstructed,  and  the  corresponding  segment  of  the 
spinal  cord  and  the  spinal  nerves  emerging  through  the  nar- 
rowed intervertebral  foramen  is  improperly  nourished,  and 
diminution  of  its  irritability  and  power  of  conductivity  results. 

From  the  foregoing  it  is  apparent  that  the  efYects  on  nerve 
function  attributed  to  vertebral  subluxaions  are  in  perfect 
accord  with  accepted  physiological  facts  and  must  therefore 
be  considered  as  scientifically  correct.  To  recapitulate:  Nerve 
impulses  travel  along  a  nerve  and  all  its  branches  and  control 
the  functional  activity  and  organic  integrity  of  the  parts  in 
which  they  end.  Pressure  upon  these  nerves  will  prevent  the 
conduction  of  these  impulses  to  the  parts  for  which  they  are 
destined,  without  necessarily  injuring  the  nerve  itself.  Ver- 
tebral subluxations  are  capable  of  producing  such  a  pressure 
on  the  nerves  emerging  through  the  intervertebral  foramina. 
Removal  of  this  pressure  by  correcting  the  subluxation  will 
again  permit  the  nerve  to  conduct  impulses  to  the  parts  for 
which  they  are  intended,  and  thus  restore  them  to  their 
normal  condition. 


SECTION  TWO 

The  Sympathetic  Nervous  System 


CHAPTER  I 
The  Anatomy  of  the  Sympathetic  Nervous  System 

A  thorough  knowledge  of  the  sympathetic  nervous  system 
is  necessary  to  an  understanding  of  chiropractic  theory  and 
technique.  This  knowledge  is  also  essential  to  understand 
how  results  are  obtained  by  the  application  of  the  "thrust"  for 
the  adjustment  of  subluxated  vertebrae.  A  comprehensive 
study  of  chiropractic  must  include  the  anatomy  of  this  por- 
tion of  the  nervous  system  in  all  its  ramifications,  from  the 
gangliated  cords  to  the  finest  filaments  which  supply  each 
cell  of  the  body.  It  must  embrace  the  exact  relationship  of 
the  sympathetic  system  with  the  cerebro-spinal  system  and 
the  cranial  nerves.  With  such  knowledge  the  clinical  results 
of  chiropractic  will  be  readily  appreciated.     Fig.  10. 

The  sympathetic  nervous  system  consists  of  (1)  a  double 
chain  of  ganglia  extending  along  the  front  and  sides  of  the 
spinal  column,  from  the  base  of  the  skull  to  the  coccyx,  and 
connected  with  each  other  by  intervening  cords.  Each  gang- 
lion is  reinforced  by  motor  and  sensory  filaments  derived  from 
the  cerebro-spinal  system,  and  thus  the  organs  under  its 
influence  are  brought  indirectly  into  communication  with  ex- 
ternal objects  and  phenomena.  (2)  Of  three  great  gangliated 
plexuses  or  collections  of  nerves  and  ganglia,  located  in  front 
of  the  spine  in  the  thoracic,  lumbar,  and  pelvic  cavities.  (3) 
Of  smaller  ganglia  situated  in  close  relation  to  the  viscera. 
(4)  Of  a  large  number  of  nerve-fibres  which  are  of  two  kinds : 
communicating,  by  which  the  ganglia  communicate  with  each 
other  and  with  the  cerebro-spinal  nerves;  and  distributory 
which  supply  the  internal  organs  and  the  coats  of  the 
blood-vessels  (Gray). 

47 


48 


SPINAL  ADJUSTMENT 


yngcal  hranches. 
brandies. 

plans. 

I  cai-diac.j)!exus, 


Solar  plexus. 


~~L.  Aortic  plexus. 


Hypogastric  plexus. 


Sacral  ganglia. 


Ganglion  impat 


Fig.  10. 

Tbe  Sympathetic  Nervous 
System   (Gray). 


SYMPATHETIC  NERVOUS  SYSTEM  49 

The  nerves  of  the  sympathetic  system  are  distributed  to 
organs  over  which  the  consciousness  and  the  will  have  no 
direct  control,  as  the  intestines,  kidneys,  liver,  heart,  etc.  The 
entire  sympathetic  series  is  in  this  way  composed  of  numer- 
ous small  ganglia  which  are  connected  throughout,  first,  with 
each  other;  second,  with  the  cerebro-spinal  system;  and  third, 
with  the  internal  viscera  of  the  body. 

The  upper  end  of  each  gangliated  cord  enters  the  cranial 
cavity  through  the  carotid  canal  by  means  of  an  ascending 
branch.  These  ascending  branches  unite  in  a  small  ganglion, 
known  as  the  ganglion  of  Ribes,  situated  upon  the  anterior 
communicating  artery. 

The  lower  end  of  each  gangliated  cord  passes  into  the 
pelvis.  Here  the  two  cords  converge  and  unite  in  a  single 
ganglion,  called  the  ganglion  impar,  situated  in  front  of  the 
coccyx. 

The  ganglia  of  these  cords  are  classified  according  to  the 
region  in  which  they  are  situated,  as  cervical,  dorsal,  lumbar 
and  sacral.  They  correspond  in  number  to  the  vertebrae 
against  which  they  lie,  except  in  the  cervical  region.  Thus 
they  are  arranged  into  the  following  classes :  The  cervical 
portion  of  the  gangliated  cord  has  three  pair  of  ganglia;  the 
dorsal  portion  has  twelve  pairs ;  the  lumbar  portion  has  four ; 
and  the  sacral  portion  has  four  or  five. 

In  the  neck  the  ganglia  are  situated  in  front  of  the  trans- 
verse processes  of  the  vertebrae ;  in  the  thoracic  region,  in 
front  of  the  heads  of  the  ribs;  in  the  lumbar  region,  on  the 
sides  of  the  bodies  of  the  vertebrae ;  and  in  the  sacral  region, 
in  front  of  the  sacrum. 

By  many,  the  ganglia  on  the  posterior  roots  of  the  spinal 
nerves,  on  the  glosso-pharyngeal  and  vagus,  and  on  the  sensory 
root  of  the  fifth  cranial  nerve  (Gasserian  ganglion)  are  also 
included  as  sympathetic-nerve  structures.     (Kirks.) 

Each  portion  of  the  gangliated  cord  will  now  be  considered 
in  turn. 

The  cervical  portion  of  the  gangliated  cord  consists  of 
three  ganglia  on  each  side,  which  are  called,  from  their 
position,  the  superior,  middle,  and  inferior. 

The  superior  cervical  ganglion  is  the  largest  of  the  three. 
It  is  located  opposite  the  second  and  third  cervical  vertebrae, 


50  SPINAL  ADJUSTMENT 

and  is  supposed  to  be  formed  by  a  coalescence  of  the  four 
ganglia  which  correspond  to  the  four  upper  cervical  vertebrae. 
It  has  five  branches,  namely,  superior,  inferior,  anterior,  in- 
ternal, and  external.  The  superior  branch  is  a  direct  upward 
extension  of  the  ganglion.  It  ascends  along  the  internal 
carotid  artery  and,  on  reaching  the  carotid  canal  in  the  tem- 
poral bone,  enters  the  cranial  cavity,  and  divides  into  two 
branches,  an  outer  and  an  inner.  The  outer  branch  distributes 
filaments  to  the  internal  carotid  artery,  and  forms  the  carotid 
plexus;  the  inner  branch  also  sends  filaments  to  the  internal 
carotid,  and,  passing  onward,  forms  the  cavernous  plexus. 
Filaments  are  sent  from  the  carotid  and  cavernous  plexuses 
to  cranial  nerves.  Their  terminal  filaments  extend  along  the 
course  of  the  internal  carotid  artery,  forming  plexuses  which 
wind  about  the  cerebral  and  ophthalmic  arteries ;  they  can 
be  traced  along  the  former  vessel  to  the  pia  mater;  along  the 
latter  vessel  they  pass  into  the  interior  of  the  eye-ball.  As 
previously  stated,  the  tilaments  which  pass  on  to  the  anterior 
communicating  artery  form  a  small  ganglion,  the  ganglion  of 
Ribes,  which  connects  the  sympathetic  cords  of  the  right  and 
left  sides. 

The  inferior  branch  of  the  superior  cervical  ganglion 
passes  downward,  and  communicates  with  the  middle  cervical 
ganglion. 

The  external  branches  of  the  superior  cervical  ganglion 
are  numerous.  They  communicate  with  the  cranial  nerves 
and  with  the  four  upper  spinal  nerves. 

The  internal  branches  are  three  in  number,  namely,  the 
pharyngeal,  laryngeal,  and  superior  cardiac  nerve.  The 
pharyngeal  branches  pass  inward  to  the  side  of  the  pharynx 
where  they  join  with  branches  from  some  of  the  cranial  nerves. 
The  superior  cardiac  nerve  is  formed  by  two  or  more  branches 
from  the  superior  cervical  ganglion,  and  also  sometimes  re- 
ceives a  filament  from  the  communicating  cord  between  the 
upper  and  middle  cervical  ganglia.  It  runs  down  the  neck 
behind  the  common  carotid  artery,  and  at  the  root  of  the  neck 
divides  into  the  right  and  the  left  superior  cardiac  nerves. 
The  right  superior  cardiac  nerve  passes  along  the  innominate 
artery  to  the  back  part  of  the  arch  of  the  aorta,  at  which  point 
it  joins  the  deep  cardiac  plexus.     It  receives  filaments  from 


SYMPATHETIC  NERVOUS  SYSTEM  51 

cranial  nerves,  and  sends  filaments  of  communication  with 
the  thyroid  branches  from  the  middle  cervical  ganglion.  The 
left  superior  cardiac  nerve  passes  along  the  common  carotid 
artery  to  the  front  of  the  arch  of  the  aorta,  where  it 
communicates  with  the  superficial  cardiac  plexus. 

The  anterior  branches  of  the  superior  cervical  ganglion 
wind  about  the  external  carotid  artery  and  its  branches,  on 
many  of  which  plexuses  are  formed.  Many  of  these  plexuses 
send  important  twigs  of  communication  with  other  nerves. 

The  middle  cervical  ganglion  is  formed  by  the  two  ganglia 
corresponding  to  the  fifth  and  sixth  cervical  vertebrae.  It  is 
often  spoken  of  as  the  thyroid  ganglion  on  account  of  its 
relation  to  the  thyroid  artery.  It  has  four  branches,  superior, 
inferior,  internal,  and  external. 

The  superior  branches  ascend  to  unite  with  the  superior 
cervical  ganglion. 

The  inferior  branches  descend  to  communicate  with  the 
inferior  cervical  ganglion. 

The  external  branches  pass  outward  and  communicate  with 
the  fifth  and  sixth  spinal  nerves. 

The  internal  branches  are  known  as  the  thyroid  and  the 
middle  cardiac  nerve. 

The  thyroid  nerve  has  small  filaments  which  accompany 
the  inferior  thyroid  artery  to  the  thyroid  gland.  They  also 
communicate  with  important  nerves. 

The  middle  cardiac  nerve  arises  from  the  middle  cervical 
ganglion  or  from  the  cord  which  connects  the  middle  and 
inferior  cervical  ganglia.  It  passes  down  the  neck  behind 
the  common  carotid  artery,  on  the  right  side ;  then  it  accom- 
panies the  trachea,  gives  off  filaments  to  other  nerves,  and 
finally  joins  the  right  side  of  the  deep  cardiac  plexus.  The 
middle  cardiac  nerve  of  the  left  side  joins  the  left  side  of 
the  deep  cardiac  plexus. 

The  inferior  cervical  ganglion  is  formed  by  the  union  of 
the  two  ganglia  which  correspond  to  the  last  two  cervical 
nerves.  It  is  located  between  the  base  of  the  transverse  proc- 
ess of  the  seventh  cervical  vertebra  and  the  neck  of  the  first 
rib,  on  the  inner  side  of  the  superior  intercostal  artery.  It 
has  four  branches,  namely,  superior,  inferior,  internal,  and 
external. 


52  SPINAL  ADJUSTMENT 

The  superior  branches  ascend  to  communicate  with  the 
middle  cervical  ganglion. 

Its  inferior  branches  descend  to  commupjcate  with  the  first 
thoracic  ganglion. 

The  external  branches  are  made  up  of  some  filaments 
which  communicate  with  spinal  nerves.  Other  filaments  ac- 
company the  vertebral  artery  in  its  upward  course  along  the 
vertebral  canal;  they  form  plexuses  along  its  course,  which 
in  turn  give  off  filaments  which  are  continued  upward  along 
the  vertebral  and  basilar  to  the  cerebral  arteries. 

The  internal  branch  is  known  as  the  inferior  cardiac  nerve. 
This  nerve  passes  downward  along  the  trachea  to  join  the 
deep  cardiac  plexus.  It  also  communicates  with  the  recurrent 
laryngeal  and  middle  cardiac  nerves. 

The  thoracic  portion  of  the  gangliated  cord  is  made  up 
of  twelve  ganglia,  corresponding  to  the  twelve  thoracic  verte- 
brae, and  named  in  the  order  of  their  position  as  first,  second, 
third,  etc.  They  are  connected  by  cords  which  are  an  exten- 
sion of  their  substance.  All  except  the  last  two  are  situated 
in  front  of  the  heads  of  the  ribs,  on  each  side  of  the  vertebral 
column.  The  last  two  ganglia  are  placed  on  the  side  of  the 
bodies  of  the  eleventh  and  twelfth  thoracic  vertebrae.  The 
thoracic  ganglia  have  external  and  internal  branches. 

The  external  branches  of  the  ganglia  are  two  in  number, 
and  communicate  with  the  corresponding  spinal  nerves. 

The  internal  branches  from  the  five  or  six  upper  thoracic 
ganglia  send  filaments  to  the  thoracic  aorta  and  its  branches; 
also  branches  to  the  bodies  of  the  vertebrae  and  their  liga- 
ments. Branches  from  the  third  and  fourth,  and  sometimes 
also  from  the  first  and  second  ganglia  form  a  portion  of  the 
posterior  pulmonary  plexus. 

The  internal  branches  from  the  six  or  seven  lower  ganglia 
send  filaments  to  the  aorta,  and  unite  to  form  the  three 
splanchnic  nerves,  namely  the  great,  the  lesser,  and  the 
smallest  splanchnics. 

The  great  splanchnic  nerve  is  formed  by  branches  from 
the  thoracic  ganglia  between  the  fifth  or  sixth  and  the  ninth 
or  tenth  ganglia.  The  fibres  from  the  roots  in  the  fifth  or 
sixth  ganglionic  branches  can  be  traced  upward  in  the  gangli- 
ated cords  as  far  as  the  first  or  second  thoracic  ganglia.    The 


SYMPATHETIC  NERVOUS  SYSTEM  53 

nerve  descends  obliquely  inward  in  front  of  the  bodies  of  the 
vertebrae,  passes  through  the  diaphragm,  and  ends  in  the 
semilunar  ganglion  of  the  solar  plexus,  sending  filaments  to 
the  renal  and  suprarenal  plexuses. 

The  lesser  splanchnic  nerve  is  formed  by  branches  from 
the  tenth  and  eleventh  thoracic  ganglia  and  also  from  the  cord 
between  them.  It  passes  through  the  diaphragm  with  the 
great  splanchnic,  and  communicates  with  the  solar  plexus.  It 
communicates  in  the  thorax  with  the  great  splanchnic,  and 
also  occasionally  sends  filaments  to  the  renal  plexus. 

The  smallest,  also  called  the  renal  splanchnic  nerve,  arises 
from  the  twelfth  thoracic  ganglion.  It  pierces  the  diaphragm, 
and  terminates  in  the  renal  plexus  and  the  lower  portion  of 
the  solar  plexus. 

The  lumbar  portion  of  the  gangliated  cord  is  placed  in 
front  of  the  spinal  column,  along  the  inner  border  of  the 
psoas  muscle,  much  nearer  the  median  line  than  the  thoracic 
ganglia.  This  portion  of  the  gangliated  cord  usually  consists 
of  four  ganglia  united  by  intervening  cords.  Each  ganglion 
has  four  branches,  namely,  superior,  inferior,  external,  and 
internal. 

The  superior  branches  of  the  lumbar  ganglia  act  as  the 
branches  of  communication  between  the  ganglia. 

The  inferior  branches  act  in  the  same  manner  as  the 
superior  in  joining  the  ganglia  with  each  other. 

The  external  branches  communicate  with  the  spinal  nerves 
of  this  region.  There  are  other  filaments  which  accompany 
the  lumbar  arteries  passing  around  the  sides  of  the  bodies 
of  the  vertebrae. 

The  internal  branches  in  part  pass  inward  in  front  of  the 
aorta,  helping  to  form  the  aortic  plexus.  Others  descend  in 
front  of  the  common  iliac  arteries  and  then  unite  in  front  of 
the  promontory  of  the  sacrum,  assisting  to  form  the  hypo- 
gastric plexus.  Many  small  filaments  are  distributed  to  the 
bodies  of  the  vertebrae  and  their  ligaments. 

The  pelvic  portion  of  the  gangliated  cord  is  located  in 
front  of  the  sacrum  along  the  inner  side  of  the  anterior  sacral 
foramina.  It  is  made  up  of  four  or  five  ganglia,  united  by 
intervening  cords.  Below,  these  cords  approach  each  other 
and  then  unite  on  the  anterior  aspect  of  the  coccyx  in  a  gang- 


54  SPINAL  ADJUSTMENT 

lion  called  the  ganglion  impar.  The  sacral  ganglia  have  the 
same  branches  as  the  preceding,  namely,  superior,  inferior, 
external,  and  internal. 

The  superior  and  inferior  branches  constitute  the  cords 
connecting  the  ganglia  above  and  below. 

The  external  branches  communicate  with  the  sacral  nerves. 
There  are  two  from  each  ganglion.  The  coccygeal  nerve  com- 
municates either  with  the  last  sacral  or  with  the  ganglion 
impar. 

The  internal  branches  communicate  with  those  of  the 
other  side,  on  the  front  of  the  sacrum.  Some  pass  onward 
to  join  the  pelvic  plexus,  while  others  form  a  plexus  about 
the  sacra  media  artery,  and  send  filaments  to  Luschka's  gland. 

The  gangliated  cords  and  their  branches  of  communication 
and  distribution  to  the  plexuses  having  been  described,  we 
will  now  direct  our  attention  to  the  consideration  of  the  great 
gangliated  plexuses,  which  constitute  the  second  of  the  four 
divisions  of  the  sympathetic  system,  as  outlined  above. 

The  three  great  gangliated  plexuses  are  the  large  aggrega- 
tions of  ganglia  and  nerves,  situated  in  the  thoracic,  abdom- 
inal, and  pelvic  cavities.  They  are  called  the  cardiac,  the  solar 
or  epigastric,  and  the  hypogastric  plexus,  respectively.  The 
nerves  which  enter  into  their  composition  are  derived  from 
the  gangliated  cords  and  from  the  cerebro-spinal  nerves. 
From  these  plexuses  branches  are  distributed  to  the  stomach, 
small  and  large  intestine,  liver,  spleen,  pancreas,  kidneys, 
supra-renal  capsules,  and  the  internal  generative  organs, 
bladder,  heart  and  lungs,  thyroid  gland,  pharynx,  larynx, 
trachea,  and  esophagus. 

The  cardiac  plexus  is  situated  at  the  base  of  the  heart. 
It  is  divided  into  a  superficial  part  which  lies  in  the  concavity 
of  the  arch  of  the  aorta,  and  a  deep  part  which  lies  between 
the  aorta  and  the  trachea.  These  two  plexuses  are  very  closely 
connected. 

The  deep  cardiac  plexus  is  situated  in  front  of  the  bifur- 
cation of  the  trachea,  above  the  point  of  division  of  the  pul- 
monary artery,  and  behind  the  arch  of  the  aorta.  It  is  formed 
by  the  cardiac  nerves  which  are  derived  from  the  cervical 
ganglia  of  the  sympathetic,  and  from  the  cardiac  branches 
of  the  pneumogastric  and  recurrent  laryngeal  nerves.     The 


SYMPATHETIC  NERVOUS  SYSTEiM  55 

only  cardiac  nerves  which  do  not  enter  into  the  formation  of 
the  deep  cardiac  plexus  are  the  left  superior  cardiac  nerve 
and  the  inferior  cervical  cardiac  branch  from  the  left  vagus. 

Some  of  the  branches  from  the  right  side  of  this  plexus 
pass  in  front  of  the  right  pulmonary  artery,  while  others  pass 
behind  it.  The  former  send  a  few  filaments  to  the  anterior 
pulmonary  plexus,  and  then  proceed  onward  to  form  a  part  of 
the  anterior  coronary  plexus. 

The  branches  from  the  left  side  of  the  deep  cardiac  plexus 
send  filaments  to  the  superficial  cardiac  plexus,  to  the  left 
auricle  of  the  heart,  and  to  the  anterior  pulmonary  plexus, 
and  then  continue  onward  to  form  the  greater  part  of  the 
posterior  coronary  plexus. 

The  superficial  cardiac  plexus  lies  under  the  arch  of  the 
aorta,  in  front  of  the  right  pulmonary  artery.  It  is  formed 
by  the  left  superior  cardiac  nerve,  by  the  inferior  cervical 
cardiac  branch  from  the  left  vagus,  and  lastly  by  filaments 
from  the  deep  cardiac  plexus.  A  small  ganglion,  the  gang- 
lion of  Wrisberg,  is  sometimes  connected  with  these  nerves, 
and,  when  present,  is  located  just  beneath  the  arch  of  the 
aorta.  The  superficial  cardiac  plexus  together  with  the  deep, 
as  mentioned  above,  forms  the  anterior  coronary  plexus,  the 
former  entering  principally  into  its  formation.  Several  fila- 
ments also  pass  along  the  pulmonary  artery  to  the  left  anterior 
pulmonary  plexus. 

The  posterior  coronary  plexus  surrounds  the  branches  of 
the  coronary  artery  at  the  back  of  the  heart,  and  filaments 
from  it  are  distributed  to  the  muscles  of  the  ventricles. 

The  anterior  coronary  plexus  passes  forward  between  the 
aorta  and  the  pulmonary  artery,  and  accompanies  the  coronary 
artery  on  the  front  of  the  heart. 

Some  anatomists  have  found  nervous  filaments  ramifying 
beneath  the  endocardium  (Valentin).  In  some  mammalia 
numerous  small  ganglia  exist  on  the  cardiac  nerves  both  on 
the  surface  of  the  heart  and  in  its  muscular  substance 
(Remak). 

The  epigastric  or  solar  plexus  consists  of  a  great  network 
of  nerves  and  ganglia,  situated  behind  the  stomach,  and  in 
front  of  the  aorta  and  the  crura  of  the  diaphragm.  It  sup- 
plies all  the  viscera  of  the  abdominal  cavity.     It  surrounds 


56  SPINAL  ADJUSTMENT 

the  celiac  axis  and  the  root  of  the  superior  mesenteric  artery, 
and  extends  down  as  far  as  the  pancreas  and  outward  as  far 
as  the  suprarenal  capsules.  The  solar  plexus  and  the  ganglia 
connected  with  it  receive  the  great  and  small  splanchnic  nerves 
of  both  sides  and  some  filaments  from  the  right  vagus. 

Of  the  ganglia  which  partly  compose  the  solar  plexus  the 
principal  are  the  two  semilunar  ganglia,  which  are  located 
one  on  each  side  of  the  plexus,  and  are  the  largest  ganglia 
in  the  body,  being  sometimes  referred  to  as  the  "Abdominal 
Brain."  They  are  large,  irregular  gangliform  masses,  formed 
by  a  collection  of  smaller  ganglia.  They  are  situated  in  front 
of  the  crura  of  the  diaphragm,  near  the  suprarenal  capsules. 
The  upper  part  of  each  ganglion  is  in  communication  with 
the  great  splanchnic  nerve,  and  to  the  inner  side  of  each  the 
branches  of  the  solar  plexus  are  connected.  From  the  semi- 
lunar ganglia  a  multitude  of  radiating  and  intertwining 
branches  are  sent  out,  which,  from  their  diverging  course 
and  their  common  origin  from  a  central  mass  are  termed  the 
solar  plexus.  From  the  solar  plexus  other  diverging  plexuses 
originate,  which  accompany  the  abdominal  aorta  and  its 
branches  and  are  distributed  to  the  stomach,  large  and  small 
intestine,  liver,  spleen,  pancreas,  kidney,  suprarenal  capsules, 
and  the  internal  organs  of  reproduction.  These  plexuses  are 
the  following: 

Phrenic  or  Diaphragmatic  plexus. 
Suprarenal  plexus. 
Renal  plexus. 
Spermatic  plexus. 
Superior  mesenteric  plexus. 
Aortic  plexus. 

'Gastric  plexus. 


Celiac  plexus 


Splenic  plexus. 
Hepatic  plexus. 


The  phrenic  plexus  arises  from  the  upper  part  of  the  semi- 
lunar ganglion.  It  receives  one  or  two  branches  from  the 
phrenic  nerve.  It  is  larger  on  the  right  side  than  the  left. 
It  accompanies  the  phrenic  artery  to  the  diaphragm  which  it 
supplies,  and  then  sends  some  filaments  to  the  suprarenal  cap- 
sule.    At  its  junction  with  the  phrenic  nerve,  on  the  right 


SYMPATHETIC  NERVOUS  SYSTEM  57 

side  is  a  small  ganglion  named  the  ganglion  diaphragmaticum, 
which  is  situated  on  the  under  surface  of  the  diaphragm  near 
the  suprarenal  capsule.  The  branches  of  this  ganglion  are 
distributed  to  the  inferior  vena  cava,  suprarenal  capsule,  and 
the  hepatic  plexus.    There  is  no  ganglion  on  the  left  side. 

The  suprarenal  plexus  is  formed  by  branches  from  the 
solar  plexus,  semi-lunar  plexus,  splanchnic  and  phrenic  nerves, 
a  ganglion  being  located  at  the  junction  with  the  former 
nerve.  It  supplies  the  suprarenal  capsule.  The  large  size  of 
the  branches  of  this  plexus  in  comparison  with  the  small  organ 
which  they  supply  is  of  much  clinical  significance. 

The  renal  plexus  is  formed  by  branches  from  the  solar 
plexus,  the  outer  part  of  the  semilunar  ganglion,  and  the 
aortic  plexus.  Filaments  from  the  lesser  and  smallest 
splanchnic  nerves  also  join  it.  There  are  about  fifteen  or 
twenty  nerves  from  these  sources,  and  they  have  numerous 
ganglia  upon  them.  They  accompany  the  branches  of  the 
renal  artery  into  the  kidney,  some  filaments  being  distributed 
to  the  spermatic  plexus  on  both  sides,  and  to  the  vena  cava 
inferior  on  the  right  side. 

The  spermatic  plexus  is  derived  from  the  renal  plexus,  and 
also  receives  some  filaments  from  the  aortic  plexus.  It  ac- 
companies the  spermatic  vessels  to  the  testes.  In  the  female 
the  ovarian  plexus  corresponds  to  the  spermatic  of  the  male, 
and  is  distributed  to  the  ovaries  and  the  fundus  of  the  uterus. 

The  celiac  plexus  is  a  direct  continuation  of  the  solar 
plexus,  and  is  of  large  size.  It  surrounds  the  celiac  axis,  and 
subdivides  into  the  gastric,  hepatic,  and  splenic  plexuses.  It 
receives  branches  from  the  splanchnic  nerves,  and,  on  the  left 
side,  a  filament  from  the  vagus. 

The  gastric  or  coronary  plexus  accompanies  the  gastric 
artery  along  the  lesser  curvature  of  the  stomach,  and  unites 
with  branches  from  the  left  vagus  nerve.  It  supplies  the 
stomach. 

The  hepatic  plexus  is  the  largest  of  the  divisions  of  the 
celiac  plexus.  It  receives  branches  from  the  left  vagus  and 
the  right  phrenic  nerves.  It  enters  the  substance  of  the  liver 
in  company  with  the  hepatic  artery  and  the  portal  vein,  and 
passes  through  the  organ  ramifying  upon  all  their  branches. 
In  this  manner  the  pyloric  plexus  is  formed,  which  accom- 


58  SPINAL  ADJUSTMENT 

panics  the  pyloric  branch  of  the  hepatic  artery  and  joins  with 
the  gastric  plexus  and  the  vagus  nerves.  There  is  also  the 
gastro-duodenal  plexus  which  further  subdivides  into  two 
plexuses,  namely  the  pancreatico-duodenal  and  the  gastro- 
epiploic. The  pancreatico-duodenal  plexus  accompanies  the 
pancreatico-duodenal  artery  to  supply  the  pancreas  and  duo- 
denum, and  joins  with  branches  from  the  mesenteric  plexus. 
The  gastro-epiploic  plexus  accompanies  the  right  gastro- 
epiploic artery  along  the  greater  curvature  of  the  stomach  and 
anastomoses  with  the  branches  from  the  splenic  plexus.  The 
cystic  plexus  also  arises  from  the  hepatic  plexus  near  the 
liver  and  supplies  the  gall  bladder. 

The  splenic  plexus  is  formed  by  branches  from  the  celiac 
plexus,  the  left  semilunar  ganglia,  and  the  right  vagus  nerve. 
It  accompanies  the  splenic  artery  and  its  branches  to  the  sub- 
stance of  the  spleen,  and,  in  its  course,  gives  off  filaments  to 
the  pancreas,  forming  the  pancreatic  plexus,  and  the  left  gas- 
tro-epiploic plexus  which  accompanies  the  left  gastro-epiploic 
artery  along-  the  convex  border  of  the  stomach. 

The  superior  mesenteric  plexus  is  a  continuation  of  the 
lower  part  of  the  solar  plexus,  and  receives  a  branch  from  the 
union  of  the  right  pneumogastric  nerve  with  the  celiac  plexus. 
It  ramifies  about  the  superior  mesenteric  artery  and  accom- 
panies it  into  the  mesentery,  where  it  divides  into  several 
secondary  plexuses.  These  plexuses  are  distributed  to  the 
corresponding  parts  supplied  by  the  artery,  namely,  pancre- 
atic plexus  to  the  pancreas ;  intestinal  branches  which  supply 
the  entire  small  intestine ;  and  ileo-colic,  right  colic,  and  mid- 
dle colic  which  supply  corresponding  parts  of  the  "large  in- 
testines. There  are  situated  upon  these  nerves  at  their  origin 
numerous  ganglia. 

The  aortic  plexus  is  formed  by  branches  which  are  de- 
rived on  each  side  from  the  solar  plexus  and  semilunar  gang- 
lia, and  also  receives  filaments  from  some  of  the  lumbar 
ganglia.  The  aortic  plexus  is  situated  upon  the  front  and 
sides  of  the  aorta,  between  the  superior  and  inferior  mesenteric 
arteries.  This  plexus  gives  oft'  the  spermatic,  inferior  mes- 
enteric, and  hypogastric  plexuses.  It  also  distributes  filaments 
to  the  inferior  vena  cava.  The  inferior  mesenteric  plexus 
which  arises  principally  from  the  left  side  of  the  aortic  plexus, 


SYMPATHETIC  NERVOUS  SYSTEM  59 

surrounds  the  inferior  mesenteric  artery.  It  gives  off  a  num- 
ber of  secondary  plexuses  which  are  distributed  to  all  the 
parts  which  are  supplied  by  that  artery,  namely,  the  left 
colic  and  sigmoidal  plexuses  which  supply  the  descending 
colon  and  sigmoid  flexure ;  and  the  hemorrhoidal  plexus  which 
supplies  the  upper  part  of  the  rectum,  and  joins  with  the  pelvic 
plexus  in  the  pelvis. 

The  hypogastric  plexus  supplies  the  viscera  of  the  pelvic 
cavity.  It  is  formed  by  the  union  of  many  filaments,  which 
descend  on  each  side  from  the  aortic  plexus  and  the  lumbar 
ganglia.  It  is  situated  in  front  of  the  promontory  of  the 
sacrum,  between  the  common  iliac  arteries.  No  ganglia  are 
demonstrable  in  this  plexus.  It  divides  below  into  two  portions, 
which  descend  on  each  side  to  form  the  pelvic  plexuses. 

The  pelvic  plexus  is  situated  at  the  side  of  the  rectum  in 
the  male,  and  at  the  side  of  the  rectum  and  the  vagina  in  the 
female.  It  supplies  the  viscera  of  the  pelvic  cavity.  It  is 
formed,  as  stated  above,  by  the  downward  continuation  of  the 
hypogastric  plexus ;  also  by  branches  from  the  second,  third, 
and  fourth  sacral  nerves,  and  by  a  few  filaments  from  the 
first  two  sacral  ganglia.  At  the  points  where  these  fibres 
join  there  are  situated  a  few  ganglia.  The  branches  from 
this  plexus  are  very  numerous,  accompany  the  branches  of 
the  internal  iliac  artery,  and  are  distributed  to  all  the  organs 
of  the  pelvis. 

The  inferior  hemorrhoidal  plexus  arises  from-  the  back 
part  of  the  pelvic  plexus.  It  supplies  the  rectum,  and  unites 
with  branches  from  the  superior  hemorrhoidal  plexus. 

The  vesical  plexus  arises  from  the  front  part  of  the  pelvic 
plexus.  The  nerves  which  make  up  this  plexus  are  very 
numerous,  and  a  large  number  of  spinal  nerves  are  contained 
among  them.  They  accompany  the  vesical  arteries,  and  are 
distributed  to  the  base  and  sides  of  the  bladder.  Many  fila- 
ments also  pass  to  the  seminal  vesicles,  and  the  vas  deferens. 
Those  fibres  which  accompany  the  vas  deferens  unite  with 
branches  from  the  spermatic  plexus  on  the  spermatic  cord. 

The  prostatic  plexus  is  a  prolongation  of  the  lower  part 
of  the  pelvic  plexus,  and  the  nerves  composing  it  are  of  large 
size.  They  are  distributed  to  the  prostate  gland,  seminal 
vesicles,   and   the   erectile   tissue   of  the   penis.     The   nerves 


60  SPINAL  ADJUSTMENT 

which  supply  the  erectile  structure  of  the  penis  are  in  two 
sets,  the  large  and  the  small  cavernous  nerves.  They  are 
slender  filaments,  and  after  uniting  with  branches  from  the 
internal  pudic  nerve,  pass  forward  below  the  pubic  arch. 
The  large  cavernous  nerve  passes  along  the  dorsum  of  the 
penis,  unites  with  the  dorsal  branch  of  the  pudic  nerve,  and 
supplies  the  corpus  cavernosum  and  spongiosum.  The  small 
cavernous  nerves  pass  through  the  fibrous  covering  of  the 
penis  near  its  roots. 

The  vaginal  plexus  arises  from  the  lower  part  of  the  pelvic 
plexus,  and  is  distributed  to  the  walls  of  the  vagina.  The 
nerves  which  make  up  this  plexus  are  similar  to  those  of 
the  vesical  plexus  in  that  they  contain  a  large  number  of 
spinal  nerves. 

The  uterine  plexus  arises  from  the  upper  part  of  the  pelvic 
plexus,  above  the  part  where  the  sacral  nerves  unite  with  this 
plexus.  Its  branches  accompany  the  uterine  arteries,  passing 
along  between  the  folds  of  the  broad  ligaments,  to  the  sides 
of  the  uterus.  They  pass  to  the  lower  part  of  the  body  of 
the  uterus  and  to  the  cervix.  Separate  filaments  pass  to  the 
body  of  the  uterus  and  the  broad  ligaments.  Branches  which 
pass  into  the  substance  of  the  organ  have  upon  them  numerous 
ganglia. 


CHAPTER  II 

The  Connection  Between  the  Sympathetic  Nervous  System 
and  the  Cerebro-Spinal  Nervous  System 

In  the  preceding  chapter  there  were  considered  the 
chain  of  ganglia  and  the  nerves  of  communication  between 
the  gangHa,  forming,  together,  the  gangliated  cords ;  also  the 
three  great  gangliated  plexuses  whose  nerves  are  derived  from 
the  gangliated  cords  and  the  cerebro-spinal  nerves;  lastly 
the  smaller  ganglia  which  are  situated  in  relation  with  the 
viscera  and  serving  as  additional  centres  for  the  origin  of  nerve 
fibres  which  penetrate  the  substance  of  the  organs  of  the 
body. 

From  the  description  which  was  given,  it  can  be  readily 
appreciated  what  a  tremendous  influence  the  sympathetic 
nervous  system  must  have  upon  the  life  processes  of  these 
organs.  Not  only  do  these  nerves  regulate  the  proper  func- 
tioning of  the  viscera,  but  the  cellular  integrity,  even,  of  the 
organs,  depends  upon  the  unimpeded  and  unhampered  action 
of  this  portion  of  the  nervous  system. 

This  is  true  for  the  reason  that  the  sympathetic  and  the 
cerebro-spinal  nervous  systems  are  not  two  distinct  and  sepa- 
rate systems,  but  are  on  the  contrary  united  with  each  other 
in  the  most  intimate  manner.  Thus  they  constitute  in  reality 
one  system,  which  is  continuous  from  the  centres  in  the 
brain  to  the  minute  fibrils  that  guide  the  destinies  of  each 
individual  cell. 

The  exact  manner  in  which  these  two  systems  are  con- 
nected with  each  other  will  be  shown  in  this  chapter.  Previ- 
ous to  taking  up  the  consideration  of  the  branches  of  com- 
munication between  the  cerebro-spinal  and  sympathetic 
systems,  however,  a  brief  review  of  the  cerebro-spinal  system 
must  be  given. 

It  must  be  constantly  borne  in  mind  that  when  the  nerv- 
ous system  is  described  as  being  formed  of  a  central  and  a 

61 


62  SPINAL  ADJUSTMENT 

peripheral  portion,  and  the  peripheral  portion  is  further  sub- 
divided into  a  spinal  and  a  sympathetic  portion,  that  such 
subdivisions  are  only  for  the  purpose  of  facilitating  topo- 
graphical descriptions.  The  nervous  system  is  show^n  by 
dissection  to  be  continuous  throughout  its  entire  extent,  and 
by  virtue  of  this  continuity  it  puts  into  connection  with  each 
other  all  the  other  systems  of  the  body. 

The  cerebro-spinal  system  consists  of  the  following 
divisions : 

1.  The  brain;  (a)  cerebrum;  (b)  cerebellum;  (c)  pons 
varolii;   (d)   medulla  oblongata. 

2.  The  spinal  cord. 

3.  The  cranial  nerves. 

4.  The  spinal  nerves. 

5.  Branches  of  communication, 

6.  Branches  of  distribution. 

The  brain  is  the  central  organ  of  the  nervous  system.  It 
is  the  seat  of  origin  of  all  impulses  which  pass  to  all  parts 
of  the  body;  and  it  receives  the  incoming  impulses,  with  the 
exception  of  those  which  are  classed  as  reflex  acts.  The  brain 
generates  the  impulses  which  govern  the  vital  processes  of 
the  body  economy,  and  which  impulses  are  transmitted  along 
the  course  of  the  nerves,  finally  reaching  every  cell  in  the 
body. 

The  spinal  cord  is  the  prolongation  of  the  brain,  in  the 
vertebral  canal.  It  is  an  elongated,  cylindrical  bundle  of 
nerve  tracts  which  convey  the  impulses  to  the  brain  from 
the  various  parts  of  the  body,  and  from  the  brain  to  the 
different  parts  of  the  body.  At  regular  points  along  its  course 
it  gives  ofif  the  roots  of  the  spinal  nerves. 

The  cranial  nerves  are  the  twelve  pairs  of  nerves  given 
off  by  the  brain,  which  pass  out  of  the  cranial  cavity  through 
foramina  in  the  skull;  they  then  pass  directly  to  the  organ 
which  they  supply. 

The  spinal  nerves  are  so  named  because  they  originate 
from  the  spinal  cord,  and  are  transmitted  through  the  interr 
vertebral  foramina.  There  are  thirty-one  pairs  of  spinal 
nerves,  which  are  classified  according  to  the  region  of  the 
spine  through  which  they  pass,  as  follows: 


CEREBRO-SPINAL  NERVOUS  SYS'lEM  63 

Cervical 8  pairs     Sacral   5  pairs 

Dorsal    12  pairs     Coccygeal 1  pair 

Lumbar 5  pairs 

It  will  be  noticed  that  the  number  of  spinal  nerves  corre- 
sponds to  that  of  the  vertebrae  of  the  corresponding  region 
except  in  the  cervical  and  coccygeal  regions. 

Each  spinal  nerve  is  formed  by  two  roots^  an  anterior  or 
motor  root,  and  a  posterior  or  sensory  root.  The  anterior 
root  is  efferent,  the  posterior  is  afferent.  The  latter  is  dis- 
tinguished by  the  presence  upon  it  of  a  ganglion,  called  the 
spinal  ganglion. 

The  Anterior  Root. — The  superficial  origin  is  from  the 
antero-lateral  columns  of  the  cord,  each  root  being  composed 
of  from  four  to  eight  filaments.  The  real  origin  is  in  the 
anterior  horns  of  the  spinal  cord.  The  anterior  roots  are 
smaller  than  the  posterior,  have  no  ganglion,  and  their  fibrils 
are  collected  into  two  bundles  near  the  intervertebral  foramen. 

The  Posterior  Root. — The  superficial  origin  is  from  the 
postero-lateral  fissure  of  the  cord.  The  real  origin  is  from 
the  nerve-cells  in  the  ganglion  on  the  posterior  root,  from 
which  they  can  be  traced  into  the  cord  in  two  main  bundles. 
The  posterior  roots  are  larger  than  the  anterior  because  there 
are  more  sensory  nerves  than  motor  in  the  body,  but  the 
individual  fibrils  composing  the  root  are  finer  than  those  of 
the  anterior  root.  The  fibrils  which  compose  the  posterior 
roots  pass  outward,  and  merge  into  two  bundles  which  enter 
the  ganglion  on  each  root.  This  ganglion  is  situated  on  the 
posterior  root  at  a  point  just  internal  to  the  place  of  junction 
of  the  posterior  root  with  the  anterior  in  the  vertebral  canal, 
and  is  located  within  the  intervertebral  foramen,  external  to 
the  point  where  the  nerves  perforate  the  dura  mater.  Three 
exceptions  to  this  location  of  the  spinal  ganglion  exist;  the 
ganglion  upon  the  first  and  second  cervical  nerves  is  placed 
on  the  arches  of  the  vertebrae  over  which  the  nerves  pass ; 
the  ganglia  of  the  sacral  nerves  are  located  within  the  spinal 
canal ;  that  of  the  coccygeal  nerve  is  also  in  the  spinal  canal, 
at  some  distance  from  the  origin  of  the  posterior  root. 

Distribution  of  the  Spinal  Nerves. — The  two  roots  unite 
just  beyond  the  ganglion,  their  fibres  become  blended,  and  the 


64  SPINAL  ADJUSTMENT 

trunk  thus  formed  constitutes  the  spinal  nerve.  The  spinal 
nerve  passes  through  and  then  out  of  the  intervertebral 
foramen,  and  divides  into  an  anterior  division  for  the  supply 
of  the  anterior  part  of  the  body,  and  a  posterior  division  for 
the  supply  of  the  posterior  part  of  the  body.  Each  of  these 
divisions  contains  fibres  from  both  roots. 

The  anterior  divisions  of  the  spinal  nerves  are  larger  than 
the  posterior  divisions.  In  the  dorsal  region  the  anterior 
divisions  of  the  spinal  nerves  are  separate  from  each  other, 
and  are  of  uniform  distribution ;  but  in  the  cervical,  lum- 
bar, and  sacral  regions  they  form  plexuses  prior  to  their 
distribution.  They  supply  the  muscles  and  skin  in  front  of 
the  spine. 

The  posterior  divisions  of  the  spinal  nerves  are  usually 
smaller  than  the  anterior.  All  except  the  first  cervical,  fourth 
and  fifth  sacral,  and  the  coccygeal  divide  into  internal 
branches.  These  branches  are  distributed  to  the  skin  and 
muscles  behind  the  spine. 

The  Sympathetics. — The  only  portion  of  the  sympathetic 
system  not  yet  considered  are  the  branches  of  communication 
between  the  cerebro-spinal  nerves  and  the  ganglia  of  the 
gangliated  cords  of  the  sympathetic  nervous  system. 
It  is  this  important  phase  of  the  subject  which  we  will  now 
consider. 

The  sympathetic  fibres  are  like  the  spinal,  both  efterent 
and  aflferent,  and  it  is  by  means  of  these  fibres  that  the  two 
systems  are  united. 

The  efferent  or  white  branches  of  communication  between 
the  ganglia  of  the  sympathetic  system  and  the  cerebro-spinal 
nerves  arise  in  the  spinal  cord ;  they  pass  out  in  the  anterior 
root,  and  then  into  the  spinal  nerve.  Here  they  join  the 
afferent  fibres  which  originate  in  the  spinal  ganglion.  The 
united  fibres  then  pass  on  into  the  anterior  primary  division 
of  the  spinal  nerve.  They  leave  this,  and,  now  known  as  the 
white  rami  communicantes,  they  pass  to  the  ganglion  of  the 
sympathetic  cord  of  the  corresponding  situation. 

The  afferent  or  gray  branches  of  communication  between 
the  sympathetic  ganglia  and  the  spinal  nerves  pass  from  the 
ganglion  of  the  sympathetic  cord  to  the  spinal  nerve,  and  are 
called  the  gray  rami  communicantes.    They  may  extend  sepa- 


CEREBRO-SPINAL  NERVOUS  SYSTEM 


65 


rately  from  the  white  rami,  or  both  kinds  of  fibres  may  be 
contained  in  a  single  bundle.  The  gray  rami  pass  through 
the  anterior  primary  division  of  the  spinal  nerve  to  the  spinal 
nerve  proper,  and  then  accompany  it  throughout  all  its 
divisions. 

The  sympathetic  fibres  that  pass  through  the  intervertebral 
foramen  are  contained  in  the  substance  of  the  spinal  nerve. 

From  the  above  the  exceedingly  intimate  connection  and 
interdependence  of  the  sympathetic  system  and  the  spinal 
nerves  is  readily  seen.  Branches  pass  from  the  spinal  nerve 
to  the  sympathetic  ganglion,  and  from  the  ganglion  to  the 
spinal  nerve,  resulting  in  a  double  interchange  taking  place 
between  the  two  systems. 

The  branches  between  the  sympathetic  ganglia  themselves 
consist  of  both  gray  and  white  nerve-fibres,  the  latter  being  a 
continuation  of  the  efferent  fibres  which  pass  from  the  spinal 
nerves  to  the  ganglia. 

The  following  table  shows  the  portion  of  the  gangliated 
cord  that  connects  with  each  of  the  spinal  nerves : 


Spinal  Nerve 


Sympathetic  System 


Cervieal   1 External  branch  from  the  superior  cervical  ganglion 

"         2 External  branch  from  the   superior   cervical  ganglion 

"        3 External  branch  from  the  superior  cervieal  ganglion 

"         4 External  branch  from  the  superior  cervical  ganglion 

sometimes  also  from  the  cord  connecting  the  supe- 
rior and  middle  cervical  ganglia 

"        5 External   branch   from   the   middle    cervical   ganglion 

"        6 External   branch    from   the   middle   cervieal   ganglion 

"        7 External  branch  from  the  inferior  cervieal  ganglion 

"        8 External  branch  from  the   inferior  cervical  ganglion 


Dorsal 


1.. 

. .  Two 

external  branches  from  the  first 

2.. 

( ( 

'           "       "    second 

3.. 

( < 

"    third 

4.. 

I  i 

"    fourth 

5.. 

.  .   " 

"       "    fifth 

6.. 

( I 

'            "        "    sixth 

7.  . 

.  .   " 

'           "       "    seventh 

8.. 

.  .   " 

'           "       "    eighth 

9.. 

<  < 

'            "        "    ninth 

10.. 

.  .   " 

'            "        "    tenth 

11.. 

<  ( 

'           "       "    eleventh 

12.. 

<  < 

"           "       "    twelfth 

thoracic   ganglion 


66 


SPINAL  ADJUSTMENT 


Spinal  Nerve  Sympathetic  System 

Lumbar   1 .  . .  .  Two  external   branches   from   the  first 


Sacral 


lumbar  ganglion 


2....   " 

"           "       "    second 

<  (             It 

3 "            " 

"    third 

i  I             11 

4 "            " 

"     fourth 

1  i             ( t 

5 "            " 

"     fifth 

it             11 

1 " 

"            "        "     first 

^.^cral            " 

2 " 

"           "       "    second 

" 

3 "            " 

"     third 

( (               I  i 

4 " 

"            "        "     fourth 

" 

5 " 

"       "    fifth 

1  (               ( ( 

Coccygeal Either  with  the  last  sacral  or  the  coccygeal  ganglion 


CHAPTER  III 

The  Connection  Between  the  Sympathetic  Nervous  System 
and  the  Cranial  Nerves 

The  Cranial  Nerves. — Prior  to  a  consideration  of  the  con- 
nection of  the  sympathetic  nervous  system  with  the  cranial 
nerves,  a  brief  review  of  the  cranial  nerves  themselves  will 
be  given  so  as  to  make  the  connection  more  clearly  defined. 

The  cranial  nerves  arise  from  certain  parts  of  the  brain, 
and  are  transmitted  through  foramina  in  the  base  of  the 
cranium.  They  are  named  numerically  according  to  the  order 
in  which  they  pass  through  the  dura  mater  lining  the  base  of 
the  skull.  Other  names  are  also  given  to  them,  according 
to  their  function  or  the  particular  system,  organ,  or  part 
of  the  body  which  they  supply. 

Taken  in  their  order,  from  before  backward,  they  are  as 
follows : 

1st — Olfactory.  7th — Facial. 

2nd — Optic.  8th — Auditory. 

3rd — Motor  oculi.  9th — Glosso-Pharyngeal. 

4th — Trochlear  (Pathetic).  10th — Pneumogastric  (Vagus). 

5th — Trifacial  (Trigeminus).  11th — Spinal  accessory. 

6th — Abducens.  12th — Hypoglossal. 

All  the  cranial  nerves  have  two  points  of  origin,  a  super- 
ficial or  apparent,  and  a  deep  or  real  origin.  The  superficial 
origin  is  from  some  part  on  the  surface  of  the  brain.  The 
deep  origin  is  from  a  special  centre  of  gray  matter,  called 
a  nucleus,  deeply  situated  in  the  substance  of  the  brain.  The 
nerves,  after  emerging  from  the  brain  at  their  apparent 
origin,  pass  through  openings  in  the  dura  mater,  leave  the 
skull  through  various  foramina,  and  then  pass  on  to  their 
final  distribution. 

The  Sympathetics  and  the  Cranial  Nerves. — Reference  to 
any  standard  work  on  anatomy  will  inform  the  reader  of  the 

67 


68  SPINAL  ADJUSTMENT 

fact  that  the  superior  cervical  ganglion  communicates  with  all 
the  cranial  nerves.  That  this  relation  is  an  exceedingly  inti- 
mate and  intricate  one  will  be  shown  by  the  following  descrip- 
tion of  the  branches  of  communication  between  these  two 
portions  of  the  nervous  system. 

We  have  seen  that  the  superior  cervical  ganglion  is  situ- 
ated in  front  of  the  transverse  processes  of  the  second  and 
third  cervical  vertebrae;  also  that  it  is  formed  by  the  coal- 
escence of  the  four  ganglia  corresponding  to  the  upper  four 
cervical  vertebrae.  The  communicating  branches  which  con- 
nect the  ganglion  with  the  spinal  nerves  are  what  make  the 
ganglion  continuous  with  the  cerebro-spinal  system,  and  per- 
mit of  the  passage  of  impulses  from  the  brain  to  the  gang- 
lion, and  from  it  to  its  various  branches  of  distribution.  The 
branches  of  communication  are  four  in  number,  and  con- 
nect with  the  four  upper  cervical  spinal  nerves.  We  saw  that 
the  sympathetic  fibres  pass  through  the  intervertebral  foramen 
in  the  substance  of  the  spinal  nerve;  therefore,  a  subluxation 
of  one  of  the  four  upper  cervical  vertebrae  will  produce  a 
direct  pressure  upon  these  branches  in  the  intervertebral 
foramen,  and  prevent  the  transmission  of  impulses  from  the 
brain,  through  the  communicating  branch  to  the  ganglion. 
The  absence  of  these  impulses  to  the  superior  cervical  gang- 
lion will  inevitably  cause  abnormalities  in  the  parts  supplied 
by  its  branches  of  distribution,  because  we  know  that  upon 
the  proper  innervation  through  the  sympathetic  system 
depends  the  health  of  any  part  of  the  body. 

The  superior  cervical  ganglion  is  the  first  ganglion  of  the 
gangliated  cord  of  the  sympathetic  nervous  system,  and  has 
the  following  five  branches :  superior,  inferior,  internal, 
external,  and  anterior. 

The  superior  branch  is  a  direct  upward  prolongation  of  the 
ganglion.  It  ascends  by  the  side  of  the  internal  carotid 
artery,  and,  entering  the  carotid  canal  in  the  temporal  bone, 
divides  into  two  branches,  an  outer,  which  forms  the  carotid 
plexus,  and  an  inner,  which  forms  the  cavernous  plexus. 

The  carotid  plexus  communicates  with  the  Gasserian  gang- 
lion of  the  fifth  cranial  nerve  from  which  are  derived  the  oph- 
thalmic, superior  maxillary,  and  inferior  maxillary  nerves, 
with  the  sixth  nerve,  the  spheno-palatine  ganglion  which  gives 


CRANIAL  NERVES  69 

off  branches  to  the  nose,  palate  and  orbit,  and  with  the  tym- 
panic branch  of  the  glosso-pharyngeal  nerve  which  supplies 
the  mucous  membrane  of  the  tympanum,  the  Eustachian  tube, 
and  the  mastoid  cells.  The  communicating  branches  with  the 
sixth  netve  consist  of  one  or  two  filaments  which  join  that 
nerve  at  the  point  where  it  lies  on  the  outer  side  of  the 
internal  carotid.  The  communication  with  the  spheno-pala- 
tine  ganglion  is  through  the  vidian  nerve  which  is  formed 
by  the  large  deep  petrosal  nerve,  a  branch  of  the  carotid 
plexus,  uniting  with  the  great  superficial  petrosal.  The 
branches  of  communication  with  the  tympanic  nerve  are  the 
small  deep  petrosal  nerve  and  the  carotico-tympanitic.  The 
Gasserian  ganglion  is  united  with  the  carotid  plexus  by  a  few 
filaments  from  the  latter. 

The  cavernous  plexus  communicates  with  the  third,  the 
fourth,  the  ophthalmic  division  of  the  fifth,  and  the  sixth 
cranial  nerves,  and  with  the  ophthalmic  ganglion.  The  branch 
of  communication  with  the  third  nerve  is  at  the  point  where 
the  latter  divides;  the  branch  of  communication  with  the 
fourth  nerve  unites  with  it  as  it  lies  on  the  outer  wall  of 
the  cavernous  sinus;  other  filaments  are  connected  with  the 
under  surface  of  the  ophthalmic  nerve ;  and  a  second  filament 
of  communication  unites  with  the  sixth  nerve ;  the  filament  of 
communication  with  the  ophthalmic  ganglion  arises  from  the 
anterior  part  of  the  cavernous  plexus. 

The  external  branches  of  the  superior  cervical  ganglion  are 
numerous,  and  send  ofif  branches  of  communication  with  the 
ganglion  of  the  trunk  of  the  pneumogastric  nerve,  and  the 
hypoglossal  nerve.  Another  filament  from  the  cervical  gang- 
lion subdivides  and  joins  the  petrosal  ganglion  of  the  glosso- 
pharyngeal nerve  and  the  ganglion  of  the  root  of  the 
pneumogastric  nerve  in  the  jugular  foramen. 

The  internal  branches  are  three  in  number :  the  pharyngeal, 
which  pass  inward  to  the  side  of  the  pharynx,  where  they 
join  with  branches  from  the  glosso-pharyngeal,  pneumogas- 
tric, and  external  laryngeal  nerves ;  the  laryngeal,  which  unite 
with  the  superior  laryngeal  nerve  and  its  branches;  the  supe- 
rior cardiac,  the  right  division  of  which  receives  filaments 
from  the  external  laryngeal  nerve  at  about  the  middle  of  the 
neck;  lower  down,  one  or  two  twigs  from  the  pneumogastric; 


70  SPINAL  ADJUSTMENT 

and  as  it  enters  the  thorax  it  is  joined  by  a  branch  from  the 
recurrent  laryngeal ;  the  left  superior  cardiac  nerve  ends  in 
the  cardiac  plexus. 

The  anterior  branches  of  the  superior  cervical  ganglion 
ramify  upon  the  external  carotid  artery  and  its  branches, 
forming  delicate  plexuses  about  them  on  the  nerves  compos- 
ing which  small  ganglia  are  sometimes  found.  The  plexus 
that  surrounds  the  external  carotid  communicates  with  a 
branch  of  the  facial  nerve ;  the  plexus  that  surrounds  the 
facial  artery  sends  one  or  two  filaments  to  the  submaxillary 
ganglion,  the  sensory  root  of  which  is  derived  from  the  lingual 
nerve,  and  the  motor  root  from  the  chorda  tympani,  both 
branches  of  the  fifth  cranial  nerve ;  the  plexus  that  accom- 
panies the  middle  meningeal  artery  sends  off  branches  that 
pass  to  the  otic  ganglion  of  the  fifth  cranial  nerve,  and  the 
geniculate  ganglion  of  the  seventh  cranial  nerve. 

We  have  seen  that  the  branches  of  communication  between 
the  spinal  nerves  and  cranial  nerves  are  efferent  or  white, 
and  afferent  or  gray.  The  white  rami  communicantes  of  all 
the  thoracic  spinal  nerves  and  the  first  two  lumbar  spinal 
nerves  connect  directly  with  the  corresponding  ganglia  of  the 
gangliated  cord.  The  first  thoracic  spinal  nerve,  however, 
sometimes  fails  to  connect  in  this  manner.  Above  the  first 
or  second  thoracic  pair  of  nerves,  therefore,  and  below  the 
second  lumbar  pair,  however,  there  is  a  different  distribution 
of  the  white  rami  communicantes. 

The  white  rami  that  are  given  off  by  the  cervical  spinal 
nerves  and  the  cranial  nerves  do  not  unite  with  the  ganglia 
of  the  gangliated  cords,  but  pass  directly  to  the  terminal 
ganglia  of  the  sympathetic  nervous  system.  The  white  rami 
of  the  lumbar  spinal  nerves,  below  the  second  lumbar  pair, 
also  pass  directly  to  the  terminal  ganglia.  The  sacral  spinal 
nerves,  also,  send  their  white  rami  to  the  terminal  ganglia, 
instead  of  first  joining  with  the  ganglia  of  the  gangliated 
cord. 

Some  of  the  branches  of  communication  between  the 
ganglia  of  the  gangliated  cord  corresponding  to  the  upper 
six  thoracic  vertebrae  continue  upward  to  unite  with  the 
superior  cervical  ganglion.  It  is  by  means  of  these  fibres 
that  the  upper  portions  of  the  gangliated  cords  are  supplied 


CRANIAL  NERVES  71 

from  the  spinal  system.  It  will  be  remembered  that  the 
white  rami  that  connect  the  ganglia  of  the  gangliated  cords  are 
a  direct  continuation  of  the  white  fibres  in  the  anterior  divi- 
sions of  the  spinal  nerves.  Since  there  is  no  direct  connection 
with  the  ganglia  and  the  cervical  spinal  and  cranial  nerves  by 
such  fibres,  an  indirect  connection  is  produced  by  the  white 
fibres  which  pass  uninterruptedly  upward  from  the  upper 
six  thoracic  segments  to  the  superior  cervical  ganglion. 

It  is  through  the  existence  of  these  fibres  of  white  rami 
communicantes  in  the  gangliated  cord  that  the  cranial  nerves 
are  influenced  by  any  interference  with  the  normal  flow  of 
nerve  impulses  as  a  result  of  subluxations  of  any  of  the 
upper  six  dorsal  vertebrae.  It  is  for  this  reason  that  adjust- 
ments in  the  upper  dorsal  region  influence  the  ear,  eye,  nose, 
throat,  and  any  other  parts  or  organs  of  the  body  supplied 
by  the  cranial  nerves. 

In  like  manner,  some  of  the  fibres  of  the  white  rami  of 
the  gangliated  cord  below  the  level  of  the  sixth  thoracic  gang- 
lion and  down  to  the  second  lumbar,  which  have  a  direct 
communication  with  the  spinal  nerves  of  the  corresponding 
region,  pass  downward,  and  in  that  manner  supply  the  lower 
portions  of  the  gangliated  cords  of  the  sympathetic  nervous 
system. 

The  gray  rami  communicantes  from  the  superior  cervical 
ganglion  communicate  with  all  the  cranial  nerves.  Some 
of  the  fibres  of  the  gray  rami  pass  to  the  origin  of  the  cranial 
nerves  in  the  brain,  while  others  accompany  the  nerves 
throughout  all  their  distribution.  The  connection  between 
the  superior  cervical  ganglion  and  the  upper  thoracic  ganglia 
of  the  gangliated  cord,  therefore,  makes  it  possible  to  correct 
any  functional  derangement  of  all  the  cranial  nerves.  Exam- 
ples of  a  clinical  nature  to  show  that  this  is  being  done  by 
means  of  chiropractic  are  exceedingly  numerous. 

The  cranial  nerves  all  connect  through  communicating 
fibres  with  the  first  four  cervical  spinal  nerves.  These  spinal 
nerves  also  are  connected  with  the  superior  cervical  gang- 
lion of  the  sympathetic  system  by  means  of  the  gray  rami. 
The  superior  branch  of  the  superior  cervical  ganglion  com- 
municates with  the  ganglion  on  the  root,  and  the  ganglion  of 
the  trunk  of  the  pneumogastric  nerve.     There  is  thus  estab- 


72  SPINAL  ADJUSTMENT 

lished  a  connection  between  the  cranial  nerves  and  the  vagus 
by  means  of  the  sympathetic  fibres.  This  connection  is  well 
illustrated  by  the  following  example :  An  individual  wit- 
nesses an  accident;  the  optic  nerve  conveys  the  impression 
to  the  visual  centers  in  the  brain ;  the  sight  of  the  accident 
produces  nausea;  the  nausea  is  simply  a  sympathetic  dis- 
turbance produced  as  a  result  of  the  connection  between  the 
optic  nerve  and  the  vagus.  The  relation  between  gastric  and 
ocular  disturbances  may  also  be  reversed ;  thus  the  visual 
disorders  accompanying  gastric  disturbances  are  readily  ex- 
plained when  the  connection  between  the  nervous  mechanism 
controlling  each  part  is  understood. 

The  following  table  shows  the  connection  between  the 
cranial  nerves  and  the  sympathetic  and  spinal  nervous  system : 

1st — Olfactory. — The  olfactory  nerve  receives  fibres  from 
the  first  to  fourth  cervical  spinal  nerves  which  receive  gray 
rami  from  the  superior  cervical  ganglion  of  the  gangliated 
cord.  It  also  connects  with  the  sympathetic  system  through 
the  vagus,  which  receives  fibres  from  the  superior  cervical 
ganglion,  which  in  turn  communicates  with  the  first  four 
cervical  spinal  nerves.  Communication  with  the  upper  thoracic 
ganglia  also  exists  through  the  ascending  fibres  of  white  rami 
connecting  with  the  superior  cervical  ganglion. 

2nd — Optic. — The  optic  nerve  is  connected  with  the  first 
and  fourth  spinal  nerves  which  receive  gray  rami  from  the 
superior  cervical  ganglion.  The  optic  also  is  connected  with 
the  ganglion  on  the  trunk  of  the  vagus  which  receives  fila- 
ments from  the  external  branches  of  the  superior  cervical 
ganglion.  Terminal  filaments  from  the  carotid  and  cavernous 
plexuses  extend  along  the  internal  carotid  artery,  forming 
plexuses  which  entwine  around  the  cerebral  and  ophthalmic 
arteries;  the  latter  plexus  passes  into  the  orbit,  and  there 
forms  another  plexus  which  accompanies  the  arteria  centralis 
retina ;  the  arteria  centralis  retina  supplies  the  optic  nerve, 
and  the  nutrition  of  this  nerve  is  thus  controlled  by  the 
superior  cervical   ganglion. 

3rd — Motor  Oculi.— The  motor  oculi  nerve  receives  a 
branch  from  the  cavernous  plexus. 

4th — Trochlear. — The  trochlear  nerve  receives  a  branch 
from  the  cavernous  plexus. 


CRANIAL  NERVES  71 

5th  —  Trigeminus. —  The  Gasserian  ganghon  receives 
branches  from  the  carotid  plexus ;  the  otic  ganglion  receives 
branches  from  the  plexus  surrounding  the  middle  meningeal 
artery;  the  spheno-palatine  ganglion  connects  with  the  supe- 
rior cervical  ganglion  through  the  large  deep  petrosal  nerve 
from  the  carotid  plexus ;  the  ophthalmic  ganglion  receives 
a  branch  from  the  anterior  part  of  the  cavernous  plexus,  and 
then  accompanies  the  nasal  nerve ;  the  submaxillary  ganglion 
receives  branches  from  the  plexus  surrounding  the  facial 
artery. 

6th — Abducens. — The  abducens  nerve  receives  branches 
from  the  carotid  and  cavernous  plexuses. 

7th — Facial. — The  geniculate  ganglion  communicates  with 
the  sympathetic  plexus  on  the  middle  meningeal  artery 
through  the  external  superficial  petrosal  nerve,  with  Meckel's 
ganglion  through  the  large  superficial  petrosal  nerve,  and 
with  the  otic  ganglion  through  the  small  superficial  petrosal 
nerve;  the  facial  nerve  also  communicates  with  the  auditory 
nerve  in  the  internal  auditory  meatus ;  with  the  auricular 
branch  of  the  pneumogastric  in  the  Fallopian  aqueduct ;  with 
the  glosso-pharyngeal,  the  pneumogastric,  the  auricularis 
magnus,  and  the  auriculo-temporal  at  its  exit  from  the  stylo- 
mastoid foramen ;  with  the  small  occipital  behind  the  ear ; 
with  the  three  divisions  of  the  fifth  on  the  face ;  and  lastly 
with  the  superficial  cervical  in  the  neck. 

8th — Auditory. — The  auditory  nerve  receives  a  branch 
from  the  geniculate  ganglion,  which  connects  with  the  su- 
perior cervical  ganglion  through  the  external  petrosal  nerve; 
it  also  connects  with  the  upper  thoracic  ganglia  of  the  gangli- 
ated  cord  through  the  connection  of  the  ascending  fibres  of 
the  white  rami  with  the  superior  cervical  ganglion. 

9th — Glosso-pharyngeal. — The  petrous  ganglion  receives 
a  branch  from  the  superior  cervical  ganglion  of  the  sym- 
pathetic; Jacobson's  nerve  receives  a  branch  from  the  carotid 
plexus  of  the  superior  cervical  ganglion ;  there  is  also  a  branch 
of  communication  with  the  pneumogastric.  namely  one  to  its 
auricular  branch  and  one  to  the  ganglion  of  the  root  of  the 
vagus ;  lastly,  it  communicates  with  the  facial  nerve. 

10th — Pneumogastric. — The  pneumogastric  nerve  com- 
municates in  the  thorax  with  the  pharyngeal,  laryngeal,  car- 


74  SPINAL  ADJUSTMENT 

diac,  pulmonary,  and  esophageal  plexuses ;  in  the  abdomen 
with  the  solar,  celiac,  gastric,  hepatic,  and  splenic  plexuses ; 
the  ganglion  of  the  root  of  the  pneumogastric  communicates 
with  the  sympathetic  by  means  of  the  external  branch  of  the 
superior  cervical  ganglion ;  the  ganglion  of  the  trunk  also 
unites  with  external  branches  from  the  superior  cervical 
ganglion ;  the  recurrent  laryngeal  branch  unites  with  the  right 
superior  cardiac  nerve,  which  is  one  of  the  internal  branches 
of  the  superior  cervical  ganglion;  the  external  laryngeal  and 
one  or  two  other  twigs  from  the  pneumogastric  also  unite  with 
the  right  superior  cardiac  nerve ;  the  recurrent  laryngeal  and 
external  laryngeal  nerves  also  communicate  with  thyroid 
branches  from  the  middle  cervical  ganglion ;  the  vagus  also 
sends  branches  of  communication  with  the  first  and  second 
cervical  spinal  nerves. 

11th — Spinal  accessory.^ — The  spinal  accessory  is  connected 
with  the  ganglion  of  the  root  of  the  vagus  by  a  few  fibres ;  it 
also  communicates  with  the  cervical  spinal  nerves ;  it  is  con- 
tinuous with  the  vagus  to  the  pharyngeal  and  laryngeal 
branches  of  the  latter ;  some  few  filaments  are  continued  into 
the  trunk  of  the  vagus  and  distributed  with  the  recurrent 
laryngeal  and  the  cardiac  nerves. 

12th — Hypoglossal. — The  hypoglossal  nerve  unites  with 
external  branches  from  the  superior  cervical  ganglion ;  it  also 
has  a  branch  from  the  first  and  second  cervical  spinal  nerve ; 
it  gives  ofT  a  branch  to  the  ganglion  of  the  trunk  of  the  vagus ; 
it  also  communicates  with  the  lingual  nerve. 

Since  all  the  cranial  nerves  connect  with  the  superior  cer- 
vical ganglion,  it  is  easily  comprehended  how  they  are  influ- 
enced by  subluxations  in  the  cervical  or  upper  thoracic  regions. 
The  connection  between  the  cranial  nerves  and  the  sympa- 
thetic nervous  system  is  as  intimate  as  that  between  the  spinal 
nerves  and  the  sympathetics.  Therefore,  any  interference 
with  the  conduction  of  impulses  from  one  system  to  the  other 
or  anything  which  prevents  a  harmonious  action,  will  produce 
disturbances  in  the  portions  of  the  body  supplied  by  the  part 
of  the  sympathetic  system  involved  in  a  subluxation  of  a 
vertebra. 


CHAPTER  IV 

The  Physiology  of  the  Nervous  System 

Having  established  the  connection  between  the  cerebro- 
spinal system  and  the  sympathetic  nervous  system,  it  now 
becomes  necessary  to  consider  the  physiology  of  the  nervous 
system.  The  physiology  of  every  portion  of  this,  the  govern- 
ing mechanism  of  the  body,  must  be  thoroughly  understood, 
for  upon  such  a  knowledge  depends  a  proper  conception  of 
disturbed  functions  or  organic  changes  in  any  organ,  part,  or 
system  of  the  body.  In  considering  this  subject  the  function 
of  each  topographical  division  of  the  nervous  system  will  be 
taken  up  separately.  It  must  be  constantly  borne  in  mind, 
as  previously  pointed  out,  that  from  a  physiological  viewpoint 
no  such  divisions  exist,  but  that  the  cerebro-spinal  and  sym- 
pathetic systems  constitute  an  entity,  both  anatomically  and 
physiologically.  The  separation  of  one  from  the  other  is 
purely  for  convenience  of  description.  In  the  present  chapter, 
therefore,  the  function  of  the  cerebro-spinal  system  will  be 
considered. 

The  Origin  of  Nerve  Impulses. — The  basic  principle  un- 
derlying the  study  of  the  physiology  of  the  nervous  system  is 
this :  that  in  the  brain  and  spinal  cord,  being  the  central  axis 
of  the  nervous  system,  all  impulses  either  originate  or  are 
received.  That  is  to  say,  all  efferent  or  out-going  impulses 
are  generated  in  the  brain ;  and  all  afferent  or  incoming  im- 
pulses terminate  in  the  brain. 

The  functional  activity  and  the  organic  integrity  of  every 
part  of  the  body  are  governed  and  maintained  by  the  efferent 
impulses,  which  originate  in  the  brain,  and  are  transmitted 
along  the  course  of  the  nerve-fibres  to  their  proper  destination. 
The  proper  relationship  of  all  parts  of  the  body,  individually 
and  collectively,  to  their  environment,  is  maintained  by  the 
flow  of  afferent  impulses  from  the  periphery  to  the  brain. 

The  Function  of  the  Nerve-Fibres. — The  office  of  nerve- 
fibres  is  to  convey  impulses.  This  is  made  possible  by  reason 
of  their  inherent  property  of  irritability  and  conductivity.   The 

75 


76  SPINAL  ADJUSTMENT 

impulse  conveyed  by  the  nerve  is  the  resultant  of  a  stimulus 
applied  to  the  end  organ  of  the  nerve  in  the  brain  or  periphery. 
The  effect  of  this  stimulus  is  produced  at  the  termination  of 
the  nerve  which  carries  the  impulse  created  by  the  stimulus. 
The  effect  of  the  stimulus,  therefore,  depends  upon  the  nature 
of  the  end  organ  of  the  nerve. 

A  nerve-fibre  is  either  afferent  or  centripetal,  or  efferent  or 
centrifugal.  The  same  fibre  cannot  be  used  for  the  one  pur- 
pose at  one  time,  and  for  the  other  at  another.  For  example, 
if  a  cerebro-spinal  nerve-fibre  is  irritated  by  electrifying  it, 
there  is  but  one  of  two  effects — either  pain  is  produced,  or 
there  is  twitching  of  a  certain  muscle  or  muscles  governed  by 
fibres  from  this  nerve.  Therefore,  when  a  nerve  is  thus  irri- 
tated, there  is  either  an  impulse  conducted  by  it  to  the  brain, 
when  there  is  pain ;  or  there  is  an  impulse  conveyed  to  the 
muscle,  when  there  is  movement. 

As  a  result  of  the  unvarying  effects  of  such  stimulation, 
nerves  have  been  classed  as  sensory  and  motor.  However, 
such  a  classification  of  nerve  function  is  not  broad  enough, 
since  the  nerves  have  other  functions.  The  electrification  of 
nerves  is  an  artificial  stimulus,  and  while  the  results  of  such  a 
stimulus  are  either  pain  or  movement,  the  natural  stimuli  on 
centripetal  nerves  do  not  always  produce  pain,  nor  is  move- 
ment always  produced  when  stimuli  are  applied  to  a  centrif- 
ugal nerve.  But  the  effects  vary,  and,  as  stated  above,  de- 
pend upon  the  nature  of  the  end-bulb  or  plate  of  the  nerve 
stimulated. 

The  effects  of  excitation  of  an  afferent  or  centripetal  nerve 
may  be  classed  as  follows: 

(a)  Pain  or  other  form  of  sensation. 

(b)  Touch. 

(c)  Taste. 

(d)  Smell. 

(e)  Hearing. 

(f)  Sight. 

(g)  Temperature, 
(h)  Muscular  sense. 

(i)     Reflex  action  of  some  kind, 
(j)     Inhibition,  restraint  of  action. 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  77 

The  effects  of  stimulation  of  an  efferent  or  centrifugal 
nerve  arc  the  following: 

(a)  Contraction  of  muscle  (motor  nerve). 

(b)  Influence  on  nutrition   (trophic  nerve). 

(c)  Influence  on  secretion  (secretory  nerve). 

(d)  Inhibit,  augment,  or  stop  another  efferent  action. 

Sensations. — Sensations  are  the  result  of  the  stimulation  of 
certain  centres  in  the  brain,  by  irritations  conveyed  to  them 
by  aft'erent  nerves.  By  means  of  these  sensations  the  mind 
obtains  a  knowledge  of  the  existence  both  of  the  various  parts 
of  the  body,  and  of  the  external  world.  For  the  production  of 
these  sensations,  three  structures  are  necessary :  first,  a  pe- 
ripheral organ  for  the  reception  of  the  impression ;  second,  a 
nerve  for  conducting  it;  third,  a  nerve-centre  for  feeling  or 
perceiving  it. 

These  sensations  are  classed  as,  (a)  Common  and  (b) 
Special. 

What  principally  distinguishes  them  is  that  by  the  common 
sensations  the  individual  is  made  aware  of  certain  conditions 
of  various  parts  of  his  body ;  while  from  the  special  sensations 
he  gains  a  knowledge  of  the  external  world  also.  This  dif- 
ference can  be  illustrated  by  comparing  the  sensations  of 
pain  and  touch,  the  former  being  a  common,  while  the  latter 
is  a  special  sensation.  If  we  touch  the  skin  with  the  point 
of  a  pin,  we  feel  the  point  by  means  of  our  sense  of  touch ; 
we  perceive  a  sensation,  and  think  of  the  object  which  caused 
it.  But  if  we  puncture  the  skin  with  the  point  of  the  pin,  a 
pain  is  felt,  a  feeling  which  is  felt  within  ourselves,  and  by 
this  sensation  we  are  not  able  to  determine  what  the  object  was 
that  caused  this  sensation,  because  a  sensation  of  pain  does 
not  refer  to  the  pin,  but  simply  to  the  fact  that  there  is  a 
changed  condition  of  the  body. 

It  must  be  remembered  that  the  seat  of  sensation  is  in  the 
sensorium  in  the  brain,  and  not  in  the  particular  end-organ 
which  receives  the  impression.  Thus  we  say  that  we  see  with 
our  eyes  and  hear  with  our  ears ;  but  these  organs  merely  re- 
ceive the  impressions,  which  being  transmitted  to  the  optic 
and  auditory  centres  in  the  brain  are  there  perceived  as  sen- 
sations and  interpreted. 


78  SPINAL  ADJUSTMENT 

If,  for  example,  the  free  flow  of  impulses  through  the 
optic  nerve  is  interrupted,  sight  is  lost,  because,  although 
the  retina  receives  the  impressions,  the  connection  between  it 
and  the  sensorium  is  broken.  A  subluxation  in  the  upper 
cervical  region  of  the  vertebral  column,  by  causing  an  inter- 
ference with  the  gray  rami  connection  between  the  cervical 
spinal  nerves  and  the  superior  cervical  ganglion  of  the 
sympathetic  system,  will  cause  the  impressions  made  upon  the 
retina  to  be  imperfectly  conveyed  to  the  sensorium  and  de- 
fective vision  results.  It  is  for  this  reason  that  spinal  adjust- 
ment in  the  upper  cervical  region  so  often  relieves  impaired 
vision. 

The  cause  of  excitation  of  some  part  of  the  brain  may  be 
some  object  of  the  external  world,  which  is  termed  an  objective 
sensation.  Or,  the  cause  of  the  excitation  may  be  due  to  some 
excitement  in  the  brain  itself,  when  it  is  called  subjective.  We 
habitually  refer  all  sensations  received  to  the  external  causes, 
even  when  they  are  in  reality  subjective.  In  this  way  illusions 
are  produced,  such  as  hearing  musical  sounds  when  the 
auditory  nerve  is  irritated,  or  seeing  various  unreal  objects 
during  delirium.  External  influences  may  also  produce  illu- 
sions of  sensation ;  for  example,  a  blow  causes  the  seeing  of 
"stars"  by  the  eye,  a  sense  of  ringing  of  the  ears,  a  salty  taste 
on  the  tongue,  and  a  shock  over  the  entire  body. 

Common  Sensations. — These  include  sensations  which  can- 
not be  referred  to  any  special  part  of  the  body,  and  are  classed 
as  follows : 

(a)  Discomfort  (including  a  sensation  referred  to  the 
fauces  and  stomach). 

(b)  Fatigue. 

(c)  Faintness. 

(d)  Hunger. 

(e)  Thirst. 

(f)  Satiety. 

(g)  Irritations  of  the  bronchial  mucous  membrane,  pro- 
ducing coughing. 

(h)  Sensations  from  various  viscera  which  indicate  a 
necessity  to  expel  their  contents,  as,  defecation,  urination, 
labor  in  the  female. 


PHYSIOLOGY  OF  NERVOUS  SYS'IEAI  79 

(i)      Itching,  creeping,  tingling,  burning,  tickling,  aching, 
(some  of  which  come  under  the  head  of  pain). 

(j)     Muscular  sense. 

(k)     Touch   is  the  connecting  link  between  the  common 
and  special  sensations. 

Special  Sensations. — These  are  the  following: 


(a) 

Touch. 

(b) 

Taste. 

(c) 

Smell. 

(d) 

Hearing. 

(e) 

Sight. 

Touch. — The  sense  of  touch  renders  us  conscious  of  the 
presence  of  a  stimulus,  from  the  mildest  to  the  most  severe 
form,  by  that  something  which  we  term  feeling,  or  common 
sensation.  The  end-organs  of  all  sensory  nerves  are  in  reality 
also  organs  of  touch,  and  upon  their  irritability  depends  the 
acuteness  of  this  sense.  All  parts  of  the  body  are  therefore 
susceptibe  to  touch,  especially  the  skin,  tongue,  and  lips. 

The  three  varieties  of  touch  are:  (1)  Touch  proper,  tactile 
sensibility  or  pressure ;  (2)   Temperature ;  (3)   Pain. 

Many  of  the  varieties  of  common  sensation  mentioned 
above  come  under  the  head  of  touch,  as  hunger,  thirst,  satiety, 
irritations,  weight,  and  itching,  creeping,  tingling,  etc.,  when 
not  amounting  to  actual  pain. 

All  these  varieties  of  touch  sensibility  are  dependent  on 
normal  irritability  and  conductivity  of  the  afferent  nerves 
from  the  periphery  to  the  sensorium.  Pressure  upon  the 
nerves  transmitted  by  the  intervertebral  foramen  will  conse- 
quently cause  disturbances  of  the  sense  of  touch,  the  clinical 
significance  of  which  will  be  explained  further  on. 

Temperature. — The  entire  surface  of  the  body  is  more  or 
less  sensitive  to  differences  of  temperature.  The  power  of 
discriminating  temperatures  may  remain  when  the  sense  of 
touch  is  temporarily  lost;  this  shows  that  there  are  special 
nerves  and  nerve-endings  for  temperature. 

The  nerves  of  temperature  convey  the  sensation  that  a 
given  object  is  cooler  or  warmer  than  the  skin.  The  tem- 
perature of  the  skin  is  thus  the  standard.     This  varies  from 


80  SPINAL  ADJUSTMENT 

hour  to  hour  according  to  the  activity  of  the  cutaneous  cir- 
culation. The  vaso-motor  nerves  of  the  sympathetic  system 
govern  the  circulation,  and  when  their  function  is  in  abeyance, 
vaso-dilation  with  increased  surface  temperature  results. 
This  physiological  fact  is  the  basis  of  the  "Heat  Test,"  used 
in  spinal  analysis,  for  when  a  nerve  is  compressed  by  a  cer- 
tain vertebra,  the  skin  of  the  segment  of  the  back  correspond- 
ing thereto  is  found  to  be  warmer,  and  it  is  a  fact  that  at  such 
segments  subluxations  can  be  invariably  found. 

Subjective  Sensations. — These,  which  are  dependent  upon 
internal  causes,  are  very  frequent  in  the  sense  of  touch.  All 
sensations  of  heat  and  cold,  pleasure  and  pain,  lightness  and 
weight,  fatigue,  etc.,  may  be  produced  by  internal  causes. 
Examples  of  subjective  sensations  are,  sensations  of  chilliness, 
creeping  of  ants  (formication)  etc.  The  mind  has  a  wonder- 
ful faculty  of  exciting  sensations  in  the  nerves  of  common 
sensibility.  Thus  the  thought  of  something  nauseating  pro- 
duces the  feeling  of  nausea ;  and  the  idea  of  pain  will  give  rise 
to  pain  in  a  part  predisposed  to  it. 

Pain. — There  are  various  views  concerning  which  nerves 
and  nerve-endings  convey  this  sensation.  That  there  is  a 
special  pain  sense  with  special  nerves  and  end-organs  is  not 
likely.  The  sensation  of  pain  is  most  probably  due  to  an  over- 
stimulation of  a  nerve  of  special  sensation  or  its  end-organ. 

Muscular  Sense. — It  is  by  means  of  this  sense  that  w'e  are 
made  aware  of  the  condition  of  the  muscles,  and  thus  obtain 
the  information  required  for  adjusting  them  to  various  pur- 
poses— standing,  walking,  grasping,  etc.  This  muscular  sen- 
sibility is  shown  by  our  power  to  estimate  the  difference  be- 
tween weights  by  the  different  muscular  efforts  required  to 
raise  them.  This  sense  must  be  distinguished  from  the  sense 
of  contact  and  of  pressure,  for  the  skin  is  the  organ  of  these. 

We  have  the  power  of  determining  beforehand  the  amount 
of  nervous  influence  necessary  for  the  production  of  a  certain 
degree  of  movement.  Thus  when  we  lift  a  vessel  the  force 
which  we  employ  in  lifting  it  depends  upon  the  idea  which 
we  have  formed  of  its  contents,  when  we  are  not  certain  what 
it  contains.  If  it  should,  therefore,  contain  something  much 
lighter  than  we  had  estimated,  useless  force  would  be  ex- 
pended, and  it  would  be  lifted  with  exceptional  ease ;  but  if  it 


PHYSIOLOGY  OF  NERVOUS  SYSTEiM  81 

contain  something  much  heavier  than  we  had  anticipated,  we 
would  very  likely  drop  it,  because  insufficient  force  was  ex- 
pended to  accomplish  the  end  desired.  This  proves  that  the 
amount  of  nerve  influence  generated  by  the  brain  must  always 
be  commensurate  with  the  amount  of  work  required  of  the 
parts  supplied  by  the  nerves.  Just  as  the  response  of  muscles 
is  proportionate  to  the  amount  of  nerve  force  received  by 
them,  so  also  are  the  functional  activities  of  all  other  parts  of 
the  body  dependent  on  this  influence.  Anything,  therefore, 
which  interferes  with  the  conduction  of  the  requisite  amount 
of  nerve  force  for  the  performance  of  its  function  by  any  organ, 
necessarily  must  be  considered  the  primary  factor  in  the  pro- 
duction of  disease  of  that  organ. 

Taste. — There  are  three  conditions  necessary  for  the  per- 
ception of  taste :  First,  the  presence  of  a  specially  endowed 
nerve-centre  and  a  nerve  to  conduct  the  stimulus  produced ; 
this  stimulus  is  the  result  of  the  production  of  a  change  in 
the  condition  of  the  gustatory  nerves,  and  this  stimulus  being 
conducted  to  the  nerve-centre  produces  the  sense  of  taste. 
Second,  the  matters  to  be  tasted  must  either  be  in  a  state  of 
solution  or  be  readily  dissolved  by  the  moisture  of  the  tongue ; 
for  this  reason  dry  powders  are  usually  tasteless,  and  merely 
produce  a  sensation  of  touch  on  the  tongue.  Third,  the  sur- 
face with  which  these  matters  come  in  contact  must  also  be 
moist,  and  the  temperature  be  of  about  100°  F. ;  therefore, 
when  the  tongue  or  fauces  are  dry,  substances  are  tasted  with 
difficulty,  even  though  they  be  moist. 

Taste,  like  any  other  sensation  is  perceived  in  the  sensorium 
in  the  brain,  and  is  usually  referred  to  the  tongue ;  but  the  soft 
palate,  uvula,  tonsils,  and  throat  are  also  endowed  with  taste. 
These  parts  derive  their  sense  of  taste  from  the  glosso- 
pharyngeal nerve,  branches  of  which  supply  them.  Besides 
the  sense  of  taste,  the  tongue  also  is  endowed  with  the  sense 
of  touch;  it  may  lose  either  of  these  senses  and  retain  the 
other.  This  shows  that  the  nervous  conductors  for  these  two 
different  sensations  are  distinct,  and  since  the  glosso-pharyn- 
geal  nerve  also  contains  fibres  of  common  sensation,  as  well 
as  the  fifth  nerve  which  supplies  the  tip  of  the  tongue  with 
taste,  the  same  nerve  trunk  may  contain  fibres  having  en- 
tirely different  properties. 


82  SPINAL  ADJUSTMENT 

Smell. — The  conditions  necessary  to  the  sense  of  smell  are 
the  following:  First,  a  special  set  of  nerves  and  nerve-end- 
ings, the  changes  in  whose  condition  produce  stimulation  of  a 
special  nerve-centre  which  perceives  the  sensation  of  odor. 
The  same  substance  which  excites  the  sense  of  smell  in  the 
olfactory  centre  may  also  cause  another  sensation  through  the 
nerves  of  taste,  and  produce  a  burning  sensation  on  the  nerves 
of  touch.  Second,  the  matters  which  stimulate  the  nerve- 
endings  which  are  either  finely  divided  particles  floating  in 
the  air  or  are  in  the  form  of  gaseous  vapors,  must  first  be 
brought  into  solution,  for  which  purpose  the  mucous  lining 
of  the  nose  must  be  moist.  When  the  Schneiderian  membrane 
is  dry,  the  perception  of  odors  is  lost,  and  thus  in  the  first 
stage  of  nasal  catarrh,  when  the  mucous  secretion  in  the 
nostrils  is  diminished,  the  sense  of  smell  is  imperfect  or  lost. 
Third,  it  is  also  essential  that  the  odorous  matter  be  trans- 
mitted through  the  nostrils  in  a  current.  This  is  accomplished 
by  breathing  through  the  nose  with  the  mouth  closed ;  we 
are  thus  able  to  control  the  sense  of  smell,  for  by  interrupting 
the  respirations  we  can  prevent  the  perception  of  odors ;  in 
like  manner  the  perception  of  odors  is  increased  by  rapid 
inspiration,  as  snififing. 

The  sense  of  smell  is  derived  from  the  olfactory  nerves. 
These  nerves  connect  with  the  superior  cervical  ganglion  of 
the  sympathetic  system,  as  do  all  the  cranial  nerves,  and  spinal 
adjustment  in  the  cervical  and  upper  dorsal  regions  restore 
the  sense  of  smell  as  well  as  of  taste  in  a  great  many  instances, 
where  no  actual  destruction  of  the  nerve  centres  has  occurred. 

Hearing. — The  essential  part  of  the  organ  of  hearing  is  the 
internal  ear.  The  other  two  portions,  namely  the  external  and 
middle  ear,  are  merely  accessory.  The  sense  of  hearing  is 
produced  by  the  exposure  of  the  filaments  of  the  auditory 
nerve  to  sonorous  vibrations.  The  auditory  nerve  filaments 
are  distributed  within  the  labyrinth  of  the  inner  ear,  which 
consists  of  a  set  of  cavities  in  the  petrous  portion  of  the 
temporal  bone.  The  labyrinth  contains  peculiar  cells,  called 
rod-cells,  which  vibrate  in  unison  with  certain  tones  and  thus 
strike  a  particular  note,  the  sensation  of  which  is  carried  to 
the  brain  by  those  filaments  of  the  auditory  nerve  with  which 
the  auditory  apparatus  is  connected. 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  83 

Subjective  sounds  are  produced  by  any  irritation  of  the 
auditory  nerve  or  other  portions  of  the  auditory  apparatus. 
Thus  are  explained  the  buzzing  and  ringing  sounds  heard  by 
those  individuals  suffering  from  nervousness,  cerebral  disease, 
vascular  congestion  of  the  head  and  ear,  and  irritation  of  the 
auditory  nerve. 

The  auditory  nerve,  being  connected  with  the  superior 
cervical  ganglion  of  the  gangliated  cord  of  the  sympathetic 
system,  may  be  influenced  by  adjustment  of  subluxated  ver- 
tebrae in  the  upper  cervical  and  upper  thoracic  regions.  Some 
cases,  however,  do  not  respond,  and  when  this  is  so,  it  is  due 
to  pathological  changes  in  the  internal  ear  as  a  result  of  long- 
continued  catarrh. 

Sight. — The  sense  of  sight  is  produced  by  the  following 
process:  A  ray  of  light  reflected  from  any  object  causes  vi- 
brations of  the  luminiferous  ether  which  are  transmitted 
through  the  iris  of  the  eye;  these  rays  then  pass  through  the 
refractive  media  of  the  eye-ball  and  finally  impinge  upon  the 
retina ;  the  endings  of  the  nerves  of  sight  in  the  retina,  namely 
the  rods  and  cones,  convey  the  impulse  thus  produced  to  the 
optic  nerve,  which  transmits  the  sensation  to  the  visual 
centres  of  the  sensorium  in  the  brain;  here  the  size,  form,  etc., 
of  the  object  are  correctly  interpreted  or  estimated. 

Numerous  instances  are  on  record  pointing  to  the  marked 
influence  exerted  by  the  sympathetic  system  upon  the  optic 
nerves,  as  shown  by  the  clinical  results  achieved  by  adjust- 
ment of  subluxated  vertebrae  in  the  cervical  and  upper  dorsal 
regions. 

Reflex  Action. — This  is  an  action  depending  upon  the 
power  possessed  by  nerve-cells  of  sending  out  to  the  periphery 
impulses  along  efferent  nerves  in  response  to  impulses  reach- 
ing them  from  afferent  nerves.  It  is  supposed  that  when  an 
impulse  reaches  a  ner\'e-cell,  a  change  in  its  metabolism  occurs, 
resulting  in  a  discharge  of  energy.  This  discharge  is  con- 
ducted out  along  the  course  of  an  efferent  nerve  as  a  stimulus, 
which  differs  in  the  action  which  it  produces  according  to 
the  nature  of  the  terminals  of  the  nerve;  the  action  which  is 
produced  may  be  secretory,  motor,  nutritive,  etc.  Such  reflex 
act  may  be  limited  in  its  effect,  or  it  may  be  extensive.  Those 
reflex  movements  which  occur  independently  of  sensation  are 


84  SPINAL  ADJUSTMENT 

generally  called  excito-motor ;  those  which  are  guided  or  ac- 
companied by  sensation,  but  not  constituting  an  intellectual 
process,  are  called  sensori-motor. 

The  following  things  are  necessary  for  the  development 
of  every  reflex  action :  (a)  One  or  more  perfect  afferent  fibres 
to  conduct  an  impression  received  at  the  periphery;  (b)  A 
nerve  centre  for  receiving  the  impression,  and  by  which  it 
may  be  reflected ;  (c)  One  or  more  efferent  fibres  along  which 
the  impression  is  conducted  outward ;  (d)  The  tissue  by  which 
the  effect  of  the  action  is  manifested.  For  the  production  of 
a  reflex  act  there  must  therefore  be  two  perfect,  unimpinged 
neurons,  a  sensory  or  afferent,  and  a  motor  or  efferent  one. 

Essentially  all  reflex  actions  are  involuntary,  although  most 
of  them  are  capable  of  being  modified,  controlled,  or  prevented 
by  a  voluntary  effort  of  the  will. 

Reflex  actions  which  are  performed  in  health  have  a  dis- 
tinct purpose,  and  are  adapted  to  producing  some  end  w^hich 
is  desirable  and  necessary  for  the  well-being  of  the  body;  in 
disease,  however,  many  of  them  are  irregular  and  purposeless. 

In  the  simplest  form  of  reflex  action  it  may  be  supposed 
that  a  single  efferent  and  afferent  neuron  are  concerned.  But 
in  the  majority  of  actual  reflex  actions  many  neurons  are  very 
likely  engaged.  The  impulse  is  carried  by  collaterals  up  and 
down  to  different  levels  of  the  cord,  and  thus  a  number  of 
groups  of  cells  are  affected. 

The  reflex  effect  produced  by  the  stimulation  of  a  sensory 
surface,  depends  not  alone  on  the  strength  of  the  stimulus,  but 
also  upon  the  condition  of  the  nerve-centre,  and  upon  the  un- 
impeded conductivity  of  the  nerves  involved  in  the  action. 

The  result  of  stimulation  of  a  reflex  centre  may  be  not 
only  an  outgoing  impulse  which  stimulates  the  parts  con- 
trolled by  its  peripheral  endings  to  activity.  It  may  also 
prevent  or  stop  an  action  already  going  on,  or  it  may  aug- 
ment, make  more  powerful  or  extensive,  or  increase  in  a  cer- 
tain direction  an  action  already  going  on. 

Automatism. — This  is  an  automatic  action  which  is  not 
dependent  for  its  discharge  upon  any  afferent  stimuli,  but  is 
produced  by  the  nerve-centre  which  of  itself  sends  out  efferent 
impulses  of  various  kinds.  The  nerve-centre  is  supposed  to 
do  this  by  the  nature  of  its  own  metabolism — the  building  up 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  85 

of  the  explosive  substance  being  anabolic,  while  the  discharge 
of  this  force  is  catabolic.  This  is  the  kind  of  impulses  which 
are  constantly  going  out  and  keep  the  muscles  in  a  state  of 
continuous  contraction  or  tone. 

Inhibition  and  Augmentation. — Not  only  may  the  move- 
ments of  muscles,  the  discharge  of  secretions  from  glands,  and 
other  actions  be  the  result  of  afferent  impulses  stimulating  the 
nerve-centres,  but  inhibition  of  such  action  which  is  already 
going  on  may  be  produced.  This  is  well  illustrated  by  the 
inhibitory  action  of  the  vagus  upon  the  contractions  of  the 
heart.  The  vagi  convey  to  the  heart  impulses  from  the  cardio- 
inhibitory  centre  which  have  a  restraining  action  upon  the 
activity  of  the  heart ;  thus  it  is  that  appropriate  afiferent 
stimuli,  as,  for  example,  when  applied  to  the  abdominal 
sympathetic,  may  increase  the  action  of  the  centre  to  such  an 
extent  as  to  altogether  stop  the  heart  during  diastole.  The 
action  of  almost  any  other  centre  may  be  inhibited  in  like 
manner  by  impulses  reaching  it ;  or  conversely,  if  appropriate 
stimuli  fail  to  reach  it,  its  action  is  disturbed,  and  the  in- 
hibitory action  is  destroyed,  so  that  the  heart,  for  example, 
beats  very  rapidly  when  all  the  afiferent  impulses  are  pre- 
vented from  reaching  the  cardio-inhibitory  centre  as  a  result 
of  a  vertebral  displacement  in  the  upper  cervical  or  upper 
dorsal  regions  of  the  spinal  column. 


CHAPTER  V 

The  Physiology  of  the  Nervous  System — (Continued) 

In  the  preceding  chapter  the  afferent  function  of  the  nerves 
was  considered;  in  this  chapter  we  will  study  their  efferent 
function. 

A  thorough  knowledge  of  the  efferent  function  of  the  nerv- 
ous system  is  as  essential  as  that  of  the  afferent  nerves,  for 
upon  such  a  knowledge  depends  a  proper  appreciation  of  the 
results  of  any  interference  with  their  action.  Such  interfer- 
ence, produced  by  pressure  upon  the  nerves  at  the  interver- 
tebral foramina,  prevents  their  conduction  of  impulses,  and 
we  have  seen  that  upon  these  impulses  depends  the  action 
which  takes  place  at  the  terminations  of  the  nerves.  Derange- 
ment of  the  function  of  the  different  parts  of  the  body  is  a 
result  of  such  impeded  nerve  action. 

Efferent  Action  of  Nerves. — The  eft'ects  of  stimulation  of 
an  efferent  or  centrifugal  nerve  are  the  following:  (a)  Con- 
traction of  muscle  (motor  nerve),  (b)  Influence  on  nutrition 
(trophic  nerve),  (c)  Influence  on  secretion  (secretory  nerve), 
(d)  Inhibit,  augment,  or  stop  another  efferent  action.  We 
will  now  consider  the  various  kinds  of  action  under  each  of 
these  heads. 

The  Motor  Functions.— Every  movement  made  by  any 
part  of  the  body  depends  upon  the  contraction  of  a  muscle  as 
a  result  of  an  efferent  impulse  to  it  from  the  nerve  which 
controls  it.  Thus,  every  conscious  and  unconscious  act  per- 
formed by  the  human  organism  is  accomplished  through  the 
medium  of  a  muscle  or  group  of  muscles.  It  is  through  muscu- 
lar action,  dependent  upon  nerve  impulses,  that  we  stand  erect, 
have  the  power  of  locomotion,  that  the  face  has  expression, 
that  the  heart  forces  the  blood  onward,  that  respiratory  move- 
ments occur,  that  the  viscera,  as  the  stomach  and  intestines, 
move  and  perform  their  functions,  that  the  secretions  of  the 
glands  are  produced,  and  so  on.  There  must  necessarily  be 
some  controlling  influence  which  guides  the  definite  and 
proper  action  of  the  muscles,  and  it  is  the  brain  which  acts 
in   this  capacity,   by  the  generating  of  impulses  which   are 

86 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  87 

transmitted  along  the  nerves.  All  the  movements  outlined 
above  are  governed  by  a  separate  and  distinct  centre  in  the 
brain,  and  depend  for  their  performance  upon  an  impulse  sent 
from  this  centre  along  the  course  of  a  special  nerve,  to  the 
muscle  which  produces  it.  Anything  which  prevents  the 
uninterrupted  conduction  of  this  impulse  prevents  action  tak- 
ing place  in  that  part  of  the  body  for  which  the  particular 
impulse  was  destined. 

Not  only  are  movements  of  the  muscles  dependent  upon 
impulses  originating  in  the  brain,  namely  elTerent  impulses, 
but  they  are  also  produced  as  a  result  of  those  external  in- 
fluences upon  the  periphery  which  cause  a  reflex  action.  The 
afferent  impulse  being  changed  to  an  efferent  one,  as  occurs 
in  a  reflex  action,  produces  a  contraction  of  a  certain  muscle, 
depending  upon  the  spinal  segment  involved. 

The  two  forms  of  motion  possessed  by  all  muscles  are 
contraction  and  relaxation.  While  the  muscle  is  contracted, 
it  is  rigid ;  while  it  is  relaxed,  it  is  lax.  When  the  nervous 
system  is  perfectly  intact,  there  is  a  continuous  flow  of  effer- 
ent impulses  which  maintain  the  muscles  in  a  state  of  constant 
contraction.  This  produces  an  exactly  balanced  state  of  con- 
traction on  corresponding  portions  of  each  lateral  half  of  the 
body.  If  there  is  a  disturbance  of  the  centre  in  the  brain,  or 
if  there  is  an  interference  with  the  flow  of  these  impulses,  or 
if  there  are  reflex  disturbances,  this  harmonious  balance  is 
disturbed,  and  is  followed  by  a  greater  contraction  of  the 
muscles  of  one  side  of  the  body  than  of  those  of  the  other 
side.  This  is  very  clearly  shown  in  facial  paralysis  where  the 
muscles  of  one  side  of  the  face  are  relaxed  and  are  conse- 
quently drawn  to  the  other  side  by  the  action  of  the  muscles 
of  the  unaffected  side,  by  the  constant  contraction  present  in 
the  latter. 

As  an  example  of  interference  with  the  conduction  of  the 
impulses  controlling  this  state  of  muscular  contraction,  we 
may  consider  a  subluxation  of  a  vertebra.  This  subluxation 
causes  pressure  upon  the  nerves  passing  through  the  cor- 
responding intervertebral  foramen  ;  these  nerves  send  branches 
to  the  ligaments  and  muscles  of  the  spinal  column ;  as  a  result 
of  the  impingement  upon  the  nerves,  the  impulses  which  are 
necessary  to  maintain  the  muscles  of  that  segment  of  the 


gg  SPINAL  ADJUSTMENT 

spine  do  not  reach  the  muscle,  and  it  becomes  relaxed ;  the 
opposite  side,  not  being  affected,  draws  the  bones,  namely 
the  vertebrae,  toward  that  side,  and  takes  the  vertebra  out 
of  its  proper  alignment.  We  see  in  this  fact  the  basis  for  the 
permanence  of  a  subluxation  until  corrected  by  mechanical 
means. 

We  are  daily  exposed  to  various  forms  of  irritation  which 
produce  stimuli  upon  the  peripheral  endings  of  afferent 
nerves.  The  impulses  thus  generated  are  transferred  to  an 
efferent  nerve-fibre  and  produce  contraction  of  the  muscle 
controlled  by  the  segment  affected.  For  example,  the  irritant 
may  be  a  draught  of  cold  air  striking  the  surface ;  this  stimu- 
lus to  the  afferent  nerves  reflexly  produces  a  contraction  of 
the  muscles  of  one  side  of  the  neck,  making  them  rigid.  This 
contraction  of  one  side  may  produce  a  subluxation  of  a  cer- 
vical vertebra;  this  may  be  so  slight  that  it  will  be  spon- 
taneously relaxed  during  sleep ;  but  if  sufficient  impingement 
of  the  nerves  is  produced,  the  displacement  may  be  permanent, 
and  lead  to  various  disorders  of  function  of  the  parts  supplied 
by  that  particular  segment  of  the  vertebral  column. 

The  Trophic  Function. — The  second  efferent  action  of 
nerves  enumerated  is  their  influence  on  nutrition.  Nutrition 
or  assimilation  is  probably  the  most  universal  of  the  five 
properties  of  all  living  matter.  By  this  term  we  designate  the 
series  of  changes  through  which  dead  matter  is  received  into 
the  structure  of  living  substance.  In  its  broadest  sense  it 
includes  the  subsidiary  processes  of  digestion,  respiration, 
absorption,  secretion,  excretion,  anabolism,  and  catabolisjn. 

Assimilation  and  disassimilation,  or  anabolism  and  cata- 
bolism,  go  hand  in  hand,  and  together  constitute  an  ever-re- 
curring cycle  of  activity  that  persists  as  long  as  life  lasts.  It 
is  designated  under  the  name  metabolism.  In  most  forms  of 
living  matter  metabolism  is  in  some  way  self-limited,  so  that 
it  gradually  becomes  less  perfect,  then  old  age  comes  on,  and 
finally  death  follows. 

The  Secretory  Function. — The  function  of  gland  cells  is 
to  produce  certain  substances  called  secretions.  These  ma- 
terials are  of  two  kinds,  namely,  those  which  are  designed  to 
perform  a  certain  function  in  the  economy,  and  those  which 
are  discharged  from  the  body  as  useless  or  injurious.     In  the 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  89 

former  case  the  materials  formed  are  termed  true  secretions, 
in  the  latter  they  are  termed  excretions. 

The  secretions  do  not  exist  in  the  same  form  in  the  blood, 
but  require  a  special  process  and  special  cells  for  their  pro- 
duction, for  example,  the  glands  of  the  stomach  for  the  forma- 
tion of  gastric  juice,  the  mammary  gland-cells  for  the  forma- 
tion of  milk,  and  so  on.  The  excretions,  however,  consist  of 
substances  which  exist  ready-formed  in  the  blood,  and  are 
merely  abstracted  from  it. 

Every  secreting  apparatus  possesses  three  essential  parts ; 
a  basement  membrane,  certain  cells,  and  blood-vessels.  These 
three  structural  elements  are  arranged  in  various  ways,  but  all 
the  varieties  come  under  two  classes,  namely,  membranes  and 
glands. 

The  principal  secreting  organs  are  the  following:  1,  the 
serous  and  synovial  membranes ;  2,  the  mucous  membranes 
with  their  special  glands,  as  the  buccal,  gastric,  and  intestinal 
glands  ;  3,  the  salivary  glands  ;  4,  the  pancreas  ;  5,  the  mammary 
glands ;  6,  the  liver ;  7,  the  lachrymal  glands ;  8,  the  skin  ;  9,  the 
kidneys;  10,  the  testes;  11,  the  ovaries;  12,  the  thyroid  gland; 
13,  the  adrenals;  14,  the  petuitary  body;  15,  the  spleen. 

The  process  of  secretion  is  greatly  influenced  by  the  nerv- 
ous system.  It  has  this  influence  by  virtue  of  its  power  of  in- 
creasing or  diminishing  the  blood-supply  of  secreting  organs ; 
also  it  exercises  a  direct  influence  upon  the  gland-cells  them- 
selves, which  may  be  called  a  trophic  influence.  Its  influence 
on  secretion  may  be  excited  by  causes  acting  directly  upon 
the  nerve-centres,  upon  the  nerves  going  to  the  secreting  or- 
gan, or  upon  the  nerves  of  other  parts.  In  the  last-named  case 
the  action  produced  is  reflex ;  thus  the  contact  of  food  with 
the  mucous  membrane  reflexly  excites  a  free  flow  of  saliva. 
Various  conditions  of  the  brain  also  may  stimulate  the  nerves 
of  secretion,  such  as  the  mere  thought  of  food  exciting  a  flow 
of  gastric  juice,  the  tears  excited  by  sorrow  or  excessive  joy, 
the  discharge  of  urine  in  hysterical  paroxysms,  etc.  Further 
facts  regarding  the  nervous  mechanism  of  secretion  will  be 
given  in  the  chapter  on  the  function  of  the  sympathetic  sys- 
tem. 

Inhibition  and  Augmentation. — These  functions  of  efferent 
nerves  have  been  considered  in  the  previous  chapter,  since 


90  SPINAL  ADJUSTMENT 

they  depend  for  their  production  upon  the  excitation  of  a 
nerve-centre  by  a  stimulus  carried  to  it  by  an  afferent  nerve. 
The  impulse  which  produces  various  forms  of  inhibition  or 
augmentation  at  the  terminals  of  the  nerves  is  a  centrifugal 
one.  Thus  the  vagi  convey  to  the  heart  from  the  cardio- 
inhibitory  centres  impulses  which  restrain  its  contractions. 

The  Cranial  Nerve  Functions. — The  physiology  of  the 
First,  Second,  and  Eighth  cranial  nerves  has  been  considered 
under  the  special  senses.  We  will  now  briefly  consider  the 
function  of  the  others. 

According  to  their  several  functions  the  cranial  nerves  may 
be  classed  as  follows : 

(a)  Nerves  of  special  sense — Olfactory,  Optic,  Auditory, 
part  of  the  Trigeminal,  and  part  of  the  Glosso-pharyngeal. 

(b)  Nerves  of  common  sensation — The  greater  part  of  the 
Trigeminal. 

(c)  Nerves  of  motion — Motor  Oculi,  Trochlear,  lesser 
division  of  the  Trigeminal,  Abducens,  Facial,  and  Hypoglossal. 

(d)  Mixed  nerves — Glosso-pharyngeal,  Pneumogastric, 
and  Spinal  accessory. 

The  1st  Nerve,  or  Optic,  is  the  nerve  of  sight. 

The  2nd  Nerve,  or  Olfactory,  is  the  nerve  of  the  sense  of 
smell. 

The  3rd  Nerve,  or  Motor  Oculi,  supplies  the  levator  palpe- 
brae  superioris  muscle,  and  all  the  muscles  of  the  eye-ball 
except  the  superior  oblique  and  external  rectus ;  also  the  iris 
and  ciliary  muscle.  The  functions  of  the  eye  derived  from 
the  impulses  through  this  nerve  are,  accommodation,  contrac- 
tion of  the  pupil,  and  movement  of  the  eye-ball. 

The  4th  Nerve,  or  Trochlear,  has  only  a  motor  function, 
supplying  the  superior  oblique  muscle  of  the  eye-ball. 

The  5th  Nerve,  or  Trigeminal,  is  a  nerve  of  special  and 
common  sensation,  and  motion.  The  first  and  second  di- 
visions are  purely  sensory ;  the  third,  or  non-gangliated  di- 
vision is  both  motor  and  sensory.  Its  motor  portion  supplies 
the  muscles  of  mastication.  Its  sensory  portion  supplies  all 
the  anterior  and  antero-lateral  parts  of  the  face  and  head  ex- 
cept the  skin  of  the  parotid  region.  It  also  confers  common 
sensibility  to  the  organs  of  special  sense.     It  also  provides 


PHYSIOLOGY  OF  NERVOUS  SYSTEM  91 

the  muscles  with  that  sensibility  without  which  the  mind, 
being  unconscious  of  their  position  and  state,  cannot  exercise 
them.  The  fifth  nerve,  further,  has  a  trophic  influence  over 
the  organs  of  special  sense. 

The  6th  Nerve,  or  Abducens,  is  exclusively  motor  and 
supplies  the  external  rectus  muscle  of  the  eye. 

The  7th  Nerve,  or  Facial,  is  the  motor  nerve  of  all  the 
muscles  of  expression,  including  the  platysma,  and  those 
muscles  of  mastication  not  supplied  by  the  fifth  nerve ;  also  the 
parotid  gland,  and  some  of  the  muscles  of  the  soft  palate. 
By  its  tympanic  branches  it  supplies  the  stapedius  and  laxator 
tympani ;  and  through  the  optic  ganglion,  the  tensor  tympani ; 
through  the  chorda  tympani  it  sends  branches  to  the  sub- 
maxillary gland  and  to  the  lingualis  and  some  other  muscular 
fibres  of  the  tongue,  and  to  the  mucous  membrane  of  its  an- 
terior two-thirds ;  and  by  branches  given  off  before  it  reaches 
the  face  it  supplies  the  muscles  of  the  external  ear,  the  pos- 
terior part  of  the  digastric  and  the  stylohyoid.  The  facial 
nerve  is  also  a  secretory  nerve,  as  it  sends  fibres  to  the  sub- 
maxillary and  parotid  glands. 

The  8th  Nerve,  or  Auditory,  is  the  nerve  of  hearing  through 
its  cochlear  branch,  and  of  equilibrium  through  its  vestibular 
branch. 

The  9th  Nerve,  or  Glosso-Pharyngeal,  contains  some  motor 
fibres  together  with  those  of  common  sensation  and  the  sense 
of  taste.  The  motor  fibres  are  distributed  to  the  palato- 
pharyngeus,  stylo-pharyngeus,  palato-glossus,  and  constric- 
tors of  the  pharynx.  Sensory  fibres  influence  the  parts 
which  it  supplies,  and  an  afferent  nerve  conveys  im- 
pressions inward  to  be  reflected  to  the  adjacent  muscles. 
The  9th  nerve,  together  with  the  chorda  tympani  and  the 
gustatory,  are  the  nerves  of  taste,  not  of  themselves,  but 
through  their  connection  with  the  Fifth  nerve.  Numerous 
experiments  have  shown  that  when  nerve  impulses  are  pre- 
vented from  passing  through  the  fifth  nerve,  the  sense  of 
taste  is  lost ;  this  is  instantaneous  when  the  nerve  is  severed, 
and  consequently  cannot  be  attributed  to  defective  nutrition 
of  the  parts ;  but  it  is  due  to  this  fact  when  the  nerve  is  com- 
pressed or  prevented  from  transmitting  the  necessary  im- 
pulses as  a  result  of  a  vertebral  subluxation. 


92  SPINAL  ADJUSTMENT 

The  10th  Nerve,  or  Vagus,  has  the  most  varied  distribu- 
tion and  functions  of  all  the  nerves.  By  its  branches  it  sup- 
plies the  following  parts :  Its  pharyngeal  branches,  which 
enter  the  pharyngeal  plexus,  supply  the  mucous  membrane  and 
muscles  of  the  pharynx.  By  the  superior  laryngeal  nerve  it 
supplies  the  mucous  membrane  of  the  under  surface  of  the 
epiglottis,  the  glottis,  the  greater  part  of  the  larynx,  and  the 
crico-thyroid  muscle.  Through  the  inferior  laryngeal  nerve 
are  supplied  the  mucous  membrane  and  muscles  of  the 
trachea,  the  lower  part  of  the  pharynx  and  larynx,  and  all 
the  muscles  of  the  larynx  except  the  crico-thyroid.  By  its 
esophageal  branches  are  supplied  the  mucous  membrane  and 
muscular  coat  of  the  esophagus.  Through  the  cardiac  nerves 
the  vagus  supplies  a  large  portion  of  the  heart  and  great  ves- 
sels. By  the  anterior  and  the  posterior  pulmonary  plexuses 
the  lungs  are  supplied.  Its  gastric  branches  supply  the 
stomach.  Through  its  hepatic  and  splenic  branches  the  liver 
and  spleen  are  partly  supplied.  Its  terminal  branches  supply 
the  intestines  and  kidneys. 

The  vagus  nerve  contains  both  sensory  and  motor  nerve- 
fibres  throughout  its  whole  course.  Its  many  functions, 
briefly  considered,  are  as  follows:  (a)  motor,  to  the  larynx 
trachea,  bronchi,  and  lungs,  the  pharynx  and  esophagus,  and 
the  stomach  and  intestines ;  (b)  sensory  and  (c)  partly  vaso- 
motor, to  the  same  regions ;  (d)  inhibitory  influence  to  the 
heart;  (e)  inhibitory  afferent  impulses  to  the  vaso-motor 
centre ;  (f )  excito-secretory  to  the  salivary  glands ;  (g)  excito- 
motor  in  coughing,  vomiting,  etc. 

The  11th  Nerve,  or  Spinal  Accessory,  supplies  the  vagus 
with  its  motor  fibres  by  its  internal  branch,  while  its  external 
branch  supplies  the  sternomastoid  and  trapezius  muscles. 

The  12th  Nerve,  or  Hypoglossal,  is  purely  a  motor  nerve, 
and  supplies  the  muscles  connected  to  the  hyoid  bone,  in- 
cluding those  of  the  tongue.  These  muscles  are  the  sterno- 
hyoid, sterno-thyroid,  and  the  omo-hyoid  through  its  descend- 
ing branch ;  the  thyro-hyoid  through  a  special  branch ;  and 
the  genio-hyoid,  stylo-glossus,  hyo-glossus,  genio-hyo-glos- 
sus,  and  linguales  through  its  lingual  branches.  When  the 
hypoglossal  nerve  is  irritated,  these  muscles  twitch,  and 
when  its  power  is  lost  entirely,  they  are  paralyzed. 


CHAPTER  VI 

The  Physiology  of  the  Sympathetic  System 

In  studying  tlie  functions  of  the  sympathetic  nervous 
system  it  must  be  constantly  borne  in  mind  that  it  is  con- 
tinuous, anatomically,  with  the  cerebro-spinal  system.  Each 
ganglion  of  the  sympathetic  system  is  reinforced  by  motor 
and  sensory  filaments  from  the  cerebro-spinal  system,  and 
thus  the  organs  under  its  influence  are  brought  directly  into 
communication  with  external  objects  and  phenomena.  The 
nerves  of  the  sympathetic  system  are  distributed  to  parts  over 
which  the  consciousness  and  the  will  have  no  control. 

The  properties  and  functions  of  the  sympathetic  system 
have  received  less  attention  than  those  of  the  cerebro-spinal 
system,  by  physiologists,  on  account  of  the  difiiculties  attend- 
ing experiments  upon  this  system.  Many  facts  have,  how- 
ever, been  brought  forth  tending  to  prove  that  the  functions 
of  this  portion  of  the  nervous  system  are  of  the  greatest  im- 
portance to  the  general  well-being  of  the  body  economy. 

The  vital  processes  in  those  structures  supplied  by  the 
gray  rami  of  the  sympathetic  ganglia  end  as  soon  as  the  con- 
nection between  the  sympathetic  and  cerebro-spinal  systems 
is  abolished.  But  the  fact  that  the  sympathetic  ganglia  do 
for  a  time  maintain  their  functional  power,  under  favorable 
conditions,  when  isolated  from  the  cerebro-spinal  system, 
shows  that  its  action  is  independent  of  the  mind.  In  other 
words,  its  functional  activity  is  automatic. 

When,  however,  the  connection  between  the  two  systems 
is  interrupted  for  a  prolonged  period,  the  action  of  the  sym- 
pathetic system  ceases,  and  disorders  of  various  kinds  become 
evident  in  those  parts  supplied  by  the  portion  which  is  thus 
cut  off.  It  has  been  shown  that  a  misplaced  vertebra  will,  by 
exercising  pressure  upon  the  spinal  nerve,  break  the  con- 
tinuity between  the  sympathetic  and  cerebro-spinal  systems, 
so  that  impulses  passing  from  the  spinal  cord  will  be  inter- 

93 


94  SPINAL  ADJUSTMENT 

rupted  at  this  point  from  going  onward  to  their  destination 
along  the  sympathetic  nerves. 

The  Functions  of  the  Sympathetic  Nervous  System, — The 
sympathetic  system  possesses  the  following  functions : 

(a)  Influence  on  Movement  and  Sensibility. 

(b)  Influence  on  Nutrition. 

(c)  Influence  on  Heat  Production. 

(d)  Influence  on  Metabolism. 

(e)  Influence  on  Circulation. 

(f)  Influence  on  Secretion. 

(g)  Influence  on  Excretion. 

(h)  Influence  on  other  existing  Action, 

(i)  Influence  on  the  Special  Senses, 

(j)  Influence  on  Reflex  Actions, 

(k)  Influence  on  the  Organs. 

Influence  on  Movement  and  Sensibility. — The  sympathetic 
system  is  endowed  with  the  power  of  conveying  impulses  of 
sensibility  and  of  exciting  motion.  These  properties  are,  how- 
ever exercised  differently  and  more  slowly  than  by  the  cere- 
bro-spinal  system.  If,  for  example,  we  irritate  a  sensory 
nerve  in  the  arm,  the  evidences  of  pain  or  reflex  action  are  in- 
stantaneous ;  on  the  other  hand  irritation  of  the  sympathetic 
nerves  and  ganglia,  while  they  give  evidence  of  sensibility 
being  manifested  here  also,  do  so  only  after  a  longer  interval 
of  time,  and  after  prolonged  application  of  the  irritant.  These 
results  correspond  very  closely  with  what  we  know  of  the 
internal  organs  which  are  supplied  almost  exclusively  by  the 
sympathetic  system,  as  in  the  liver,  lungs  and  kidneys.  These 
organs,  as  is  well  known,  are  poorly  endowed  with  nerves  of 
common  sensation ;  we  are  not  conscious  of  the  changes  and 
operations  going  on  in  them.  Nor  are  they  very  sensitive  to 
pain.  But  they  are  capable  of  causing  the  perception  of  sen- 
sations after  prolonged  or  unusual  irritation,  and  become  very 
painful  when  inflamed  for  some  time.  Since,  as  stated  above, 
these  organs  are  supplied  nearly  entirely  by  nerve  fibres  from 
the  sympathetic  system,  these  facts  show  that  the  power  of 
sensibility  is  possessed  by  this  portion  of  the  nervous  system. 

There  is  the  same  peculiarity  of  action  of  the  sympathetic 
system  in  its  motor  function.    If,  for  example,  the  facial  nerve 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  95 

is  irritated,  the  spasms  of  the  muscles  which  it  controls  are 
instantaneous,  violent,  and  of  short  duration.  If,  however, 
the  semilunar  ganglion  be  irritated,  it  is  only  after  a  few 
seconds  that  a  slow,  peristaltic  contraction  of  the  intestine 
takes  place,  which  continues  for  some  time  after  the  exciting 
cause  has  been  removed. 

Morbid  changes  taking  place  in  the  organs  supplied  by  the 
sympathetic  system  thus  present  a  similar  peculiarity  in  the 
mode  of  their  production.  If  the  body,  for  example,  be  ex- 
posed to  cold  and  dampness,  congestion  of  the  kidneys,  per- 
haps, shows  itself  on  the  following  day.  Inflammation  of  the 
internal  organs,  as  is  well  known,  is  very  rarely  produced 
within  twelve  or  twenty-four  hours  after  the  application  of 
the  exciting  cause. 

Influence  on  Nutrition. — It  is  essential  that  all  parts  of 
the  body  be  nourished  if  they  are  to  functionate  normally  and 
maintain  their  organic  integrity.  The  nerves  themselves  must 
be  nourished  in  order  to  retain  their  power  of  conveying  im- 
pulses ;  in  fact  mal-nutrition  is  one  of  the  causes  of  disturbed 
nerve-action.  The  nutrition  of  every  cell  in  the  body  depends 
upon  the  trophic  influence  of  the  nerve-fibres  of  the  sym- 
pathetic system. 

The  exact  manner  in  which  the  nerves  influence  nutritive 
processes  is  not  as  yet  well  understood.  But  since  nutrition 
is  simply  the  building  up  of  parts  of  the  body,  and  since  nu- 
tritive materials  must  first  be  digested,  before  they  can  be 
absorbed,  conveyed  to  the  cells,  and  assimilated,  it  is  readily 
apparent  what  a  great  number  of  individual  processes  enter 
into  the  accomplishment  of  that  single  end,  which  we  term 
nutrition.  Since  all  these  processes  which  make  the  ultimate 
nutrition  of  the  cells  possible  are  governed  by  nerve-impulses, 
it  cannot  be  questioned  that  the  nerves  control  nutrition 
primarily.  Whether  or  not  there  are  special  nerves  which 
govern  the  nutritive  process  within  the  cell  itself  has  been 
much  debated,  and  evidence  seems  to  support  the  theory  that 
there  are  such  nerves. 

These  nerves  have  been  termed  katabolic  and  anabolic 
nerves.  It  is  supposed  that  every  tissue  is  supplied  with  two 
sets  of  nerves,  the  anabolic,  which  subserve  constructive 
metabolism,   and   the  katabolic   nerve   which    stimulates   de- 


96  SPINAL  ADJUSTMENT 

structive  metabolism.  The  augmentor  nerves  are  the  kata- 
bolic  nerves;  the  inhibitory  nerves  are  the  anabolic  nerves. 
Stimulation  of  a  katabolic  nerve  produces  increased  activity, 
increased  metabolism,  and  is  followed  by  exhaustion,  and  a 
breaking  dow^n  of  tissue.  Such  a  nerve  is  illustrated  by  the 
sympathetic  augmentor  nerve  of  the  heart,  on  stimulation  of 
which  increased  activity  of  the  heart  takes  place,  followed  by 
exhaustion.  Stimulation  of  the  anabolic  nerve,  however,  pro- 
duces diminished  activity,  repair  of  tissue  and  building  up. 
The  cardiac  vagus  is  an  illustration  of  such  a  nerve,  stimula- 
tion of  which  produces  inhibition. 

No  nerve-impulses  are  generated  without  some  form  of 
stimulus  acting  upon  the  nerve-centre,  and  it  is  therefore  not 
sufficient,  to  dispose  of  the  subject  of  trophic  nerve-action  by 
saying  that  there  exist  nerves  which  send  out  impulses  which 
regulate  this  function,  without  giving  some  explanation  as 
to  where  these  impulses  originate.  It  is  not  only  necessary 
that  sufficient  nutritive  materials  be  ingested  by  the  body  so 
that  the  balance  between  repair  and  waste  may  be  preserved, 
but  the  use  of  these  materials  must  be  regulated  also.  The 
digestive,  secretory,  and  absorptive  apparati  can  accomplish 
only  a  certain  amount  of  work,  that  is  to  say,  can  prepare 
for  assimilation  by  the  body  only  a  certain  amount  of  nutritive 
material  for  its  constructive  metabolism.  Assuming,  there- 
fore, that  a  certain  amount  of  this  latent  energy  is  available, 
the  activities  of  the  body  must  be  proportioned  to  this  energy. 
The  nerves  that  govern  the  activity  of  a  part  must  therefore 
regulate  this  activity  in  such  a  way  that  the  output  of  energy 
will  never  exceed  the  income.  If,  for  example,  the  augmentor 
nerve  of  a  certain  organ  and  the  inhibitory  nerve  of  the  same 
organ  are  not  acting  harmoniously,  the  waste  processes  on 
account  of  excessive  action  may  become  excessive,  and  the 
nutrition  of  the  organ  will  suffer  because  of  the  failure  of  the 
inhibitory  nerve  to  suspend  or  retard  its  activity  for  a  time, 
and  permit  the  necessary  reparative  processes  to  take  place 
during  the  interval  of  rest.  Thus  the  nerves  assume  trophic 
functions  as  a  result  of  afferent  impulses  reaching  their  centre. 
These  impulses  are  generated  as  a  result  of  the  stimulus 
created  at  the  terminals  of  the  nerves  in  the  organs.  These 
stimuli  are  excited  by  the  state  of  exhaustion  in  the  cells,  and 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  97 

it  is  well  known  that  exhaustion  is  one  of  the  common  sensa- 
tions also  of  the  cerebro-spinal  nerves.  In  the  organs  ex- 
haustion is  not  perceived  as  such  by  the  sensonum  in  the 
brain,  but  efferent  impulses  are  sent  out  retarding  the  activ- 
ity of  the  organ  until  sufficient  rest  can  be  secured  to  permit 
the  building  up  processes  to  occur.  In  this  way  is  the  nutri- 
tion of  all  parts  maintained,  namely  by  regulating  the  activ- 
ity of  a  part,  through  the  balanced  action  of  the  augmentor 
or  katabolic  and  the  inhibitory  or  anabolic  nerves. 

Influence  on  Heat  Production. — One  of  the  most  import- 
ant results  of  the  metabolism  of  the  tissues  is  the  production 
of  the  heat  of  the  body.  It  is  by  this  means  that  the  tempera- 
ture of  the  body  is  raised  to  such  a  point  as  to  make  life  pos- 
sible. The  chief  part  of  the  metabolic  changes  in  the  tissues 
is  of  the  nature  of  oxidation,  since  the  oxygen  taken  into 
the  system  is  ultimately  combined  with  carbon  and  hydrogen 
and  discharged  as  carbonic  acid  and  water.  Any  changes 
which  occur  in  the  protoplasm  of  the  tissues  resulting  in  a 
manifestation  of  their  functions,  are  attended  by  the  evolution 
of  heat  and  the  production  of  carbonic  acid  and  water.  The 
more  active  the  tissue,  the  greater  will  be  the  amount  of 
heat  produced,  and  the  amount  of  carbonic  acid  and  water 
formed.  But  in  order  that  the  protoplasm  may  perform  its 
function  the  waste  of  its  own  tissue  must  be  repaired  by  a 
due  supply  of  good  material  to  be  changed  into  its  own 
substance. 

The  heat-producing  tissues  are  the  following:  (a)  The 
muscles,  which  form  such  a  large  part  of  the  body,  and  in 
which  metabolism  is  particularly  active,  supply  the  principal 
part  of  the  heat  produced  in  the  body,  (b)  The  secreting 
glands,  and  especially  the  liver,  since  it  is  the  largest,  come 
next  to  the  muscles  as  heat-producing  tissue.  It  has  been 
found  by  experiments  that  the  blood  which  leaves  the  glands 
is  much  warmer  than  that  which  enters  them.  The  metabolism 
in  the  glands  is  very  active,  and  as  we  have  seen,  the  more 
active  the  metabolism,  the  greater  the  heat  produced,  (c) 
The  brain  ranks  next  as  a  heat  producing  tissue,  (d)  It  must 
be  remembered  that  although  the  above  organs  are  the  chief 
sources  of  heat  in  the  body,  that  all  parts  contribute  their 
share,   in   proportion   to  their  activity.     The  blood   itself   is 


98  SPINAL  ADJUSTMENT 

the  seat  of  metabolism,  and  therefore  also  contributes  some- 
thing to  the  heat  of  the  body,  although  a  very  small  amount. 
Two  other  minor  means  of  heat-production  are,  friction  of 
parts  of  the  body,  as  the  circulation  of  the  blood,  movement, 
of  the  muscles,  etc. ;  and  the  ingestion  of  warm  food  and 
drink. 

The  normal  temperature  of  the  body  is  maintained  under 
the  varying  conditions  to  which  the  body  is  exposed  by 
mechanisms  which  permit  (1)  variation  in  the  loss  of  heat, 
and  (2)  variations  in  the  production  of  heat.  Thus  in  normal 
warm-blooded  animals  the  loss  and  gain  of  heat  are  so  well 
balanced  that  a  uniform  temperature  is  maintained. 

The  loss  of  heat  from  the  body  is  through  the  following 
avenues :  (a)  By  radiation  and  conduction  from  its  surface ; 

(b)  By  continuous  evaporation  of  water  from  the  same  part; 

(c)  By  the  respiration  of  air  some  loss  of  heat  occurs ;  (d)  All 
food  and  drink  which  enters  the  body  at  a  lower  temperature 
also  abstracts  some  of  the  heat  of  the  body ;  (e)  The  urine  and 
feces  leaving  the  body  also  occasion  the  loss  of  a  small  amount 
of  heat. 

We  have  the  power  of  heat  production  as  well  as  heat 
dissipation.  Each  individual  has  his  own  coefficient  of  heat 
production.  Since,  as  has  been  said,  the  amount  of  heat 
varies  with  the  metabolism  of  the  tissues  of  the  body,  every- 
thing which  increases  that  metabolism  will  increase  the  heat 
production.  The  ingestion  of  food  increases  the  metabolism 
of  the  tissues,  and  accordingly  the  rate  of  heat  production  in 
the  dog  is  found  to  be  increased  after  a  meal,  and  reaches  its 
height  six  to  nine  hours  after  the  meal.  The  kind  of  food 
eaten  also  has  an  effect  upon  the  amount  of  heat  produced, 
and  thus  when  sugar  is  added  to  the  meal  given  the  dog  in 
the  experiment  proving  these  facts,  it  was  found  that  still 
more  heat  was  produced.  Fat  is  also  used  to  increase  the 
production  of  heat,  as  is  evidenced  by  the  large  amounts  of 
fat  eaten  by  those  who  live  in  a  cold  climate  to  produce  the 
requisite  amount  of  heat.  Exercise  is  an  important  measure 
for  the  production  of  heat,  as  through  it  the  metabolism  of 
the  muscles  is  increased. 

The  influence  of  the  nervous  system  in  the  production  of 
heat  is  very  marked  for  upon  the  nervous  influence  depends 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  99 

the  metabolism  of  the  tissues.  The  facts  which  best  prove 
this  are  these :  First,  when  the  nerve  supply  to  a  part  is  cut 
off,  the  temperature  of  that  part  soon  falls  below  its  usual 
degree ;  second,  when  death  is  caused  by  a  serious  injury  of 
the  nerve-centres,  the  temperature  of  the  body  rapidly  falls, 
even  though  the  circulation  be  maintained,  artificial  respira- 
tion performed,  and  all  the  chemical  processes  of  the  body 
are  in  operation ;  third,  if  the  nerves  of  a  limb  are  severed  or 
compressed,  it  becomes  cold ;  fourth,  by  its  power  of  controll- 
ing the  calibre  of  the  bloodvessels  the  nervous  system  also 
governs  the  temperature  of  the  body. 

In  addition  to  this  regulation  of  temperature  by  the  vaso- 
motor influence  of  the  nervous  system,  there  is  a  separate 
nervous  apparatus,  by  means  of  which  heat  production  and 
heat  loss  are  regulated  as  circumstances  demand.  This  ap- 
paratus consists  of  centres  which  may  be  reflexly  stimulated 
by  afferent  impulses  from  the  skin,  and  which  act  through 
special  efferent  nerves  supplying  the  various  tissues.  Any 
disturbance  of  this  reflex  arc  will  produce  a  temperature  higher 
than  normal.  For  example,  a  patient  suffering  from  fever, 
has  a  body  temperature  several  degrees  higher  than  normal. 
While  this  increase  of  temperature  is  no  doubt  due  to  dimin- 
ished loss  of  heat  from  the  skin,  this  is  far  from  being  the 
only  cause  of  the  fever.  The  amount  of  oxygen  taken  in  and 
the  amount  of  carbon  dioxide  given  out  are  both  increased, 
and  with  this  there  must  be  increased  metabolism  of  the 
tissues,  and  especially  of  the  muscular  tissue,  because  in 
these  cases  the  amount  of  urea  excreted  by  the  urine  is  always 
increased.  We  are  all  familiar  with  the  rapid  wasting  which 
accompanies  high  fevers ;  this  means  that  the  metabolism  is 
not  only  too  rapid,  but  also  that  insufficient  time  is  had  for 
the  tissues  to  build  up.  In  fever,  then,  there  must  be  some 
interference  in  the  ordinary  channel  by  which  the  skin  is 
able  to  communicate  to  the  nervous  system  the  necessity  of 
an  increased  or  a  diminished  production  of  heat  in  the  mucles 
and  other  tissues.  The  only  logical  place  at  which  such  an 
interference  could  occur  is  at  the  intervertebral  foramina, 
where  the  nerves  pass  between  movable  bones.  As  a  result  of 
this,  and  in  spite  of  the  condition  of  heat  of  the  surface  of 
the  body,  the  production  of  heat  goes  on  at  an  abnormal  rate, 


100  SPINAL  ADJUSTMENT 

constituting  what  we  term  fever.  It  might  by  appropriately 
mentioned  in  this  connection  that  upon  this  physiological 
fact  depend  the  remarkable  results  obtained  by  spinal  ad- 
justment in  reducing  a  fever. 

Influence  on  Metabolism. — Something  has  already  been 
said  of  the  influence  of  the  sympathetic  system  on  metabolism, 
in  connection  with  its  influence  on  nutrition.  As  a  matter  of 
fact,  the  influence  of  this  system  on  metabolism  is  so  closely 
interwoven  with  all  its  other  functions  that  this  action  is  not 
an  isolated  one,  but  is  the  prime  action  about  which  revolve 
all  the  activities  of  the  body  economy,  as  influenced  by  the 
nervous  system. 

The  processes  of  constructive  and  destructive  metabolism 
are  under  the  control  of  special  nerve-fibres  of  the  sympathetic 
system.  In  the  case  of  the  submaxillary  gland,  for  example, 
if  the  chorda  tympani  is  stimulated,  there  is  a  thin,  watery 
secretion  obtained,  which  contains  only  1  or  2  per  cent  of 
solids ;  if  the  sympathetic  is  stimulated  in  the  cervical  region, 
a  thick,  turbid  secretion  is  obtained,  which  contains  as  much 
as  6  per  cent  of  solids.  In  the  former  case,  there  is  vaso-dila- 
tion,  an  increased  flow  of  blood  through  the  gland  occurs,  and 
it  has  a  ruddy  color.  In  the  latter  case,  there  is  vaso-con- 
striction,  a  diminished  flow  of  blood  occurs,  and  the  gland  is 
pale.  Experiments  have  disproved  the  old  theory  that  the 
amount  of  secretion  depends  upon  the  vaso-motor  effect. 
What  it  does  show  is  that  the  sympathetic  system  stimulates 
the  metabolism,  as  shown  by  the  much  greater  richness  of 
the  secretion  obtained  by  stimulation  of  the  sympathetic, 
as  compared  with  that  obtained  when  the  chorda  tympani 
is  stimulated.  This  increased  richness  is  a  result  of 
greater  protoplasmic  activity,  which  is  synonymous  with 
metabolism. 

Another  evidence  of  the  effect  of  the  sympathetic  system 
on  metabolism  is  shown  by  the  following  experiment :  When 
the  cerebral  fibres  controlling  the  parotid  gland  of  a  dog 
were  stimulated,  an  abundant,  thin,  and  watery  saliva  was 
obtained.  Stimulation  of  the  sympathetic  fibres  alone,  with 
the  tympanic  nerve  cut,  and  the  cerebral  fibres  not  previously 
stimulated,  produced  no  secretion  at  all.  But  by  this  stimu- 
lation of  the  sympathetic  a  marked  effect  was  produced  on 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  101 

the  gland ;  this  was  shown  by  the  fact  that  subsequent  or 
simultaneous  stimulation  of  the  cerebral  fibres  gave  a  secre- 
tion of  saHva  very  different  from  that  obtained  on  stimulating 
the  cerebral  fibres  alone,  in  that  it  was  very  rich  in  organic 
constituents.  When  the  sympathetic  nerve  is  stimulated 
previous  to  stimulating  the  cerebral  fibres,  the  saliva  may  be 
ten  times  as  rich  as  when  only  the  cerebral  fibres  are  stimu- 
lated. This  shows  that  by  stimulation  of  the  sympathetic 
the  metabolism  was  so  stimulated  to  activity  that  when  the 
cerebral  fibres  were  stimulated,  the  products  of  this  increased 
metabolism  were  obtained  in  the  saliva. 

Influence  on  Circulation. — Perhaps  the  most  important 
fact  concerning  the  sympathetic  system  is  its  influence  over 
the  vascularity  and  nutrition  of  the  parts  supplied  by  it.  First 
of  all,  the  division  of  the  sympathetic  nerves  immediately  pro- 
duces a  vascular  congestion  in  the  corresponding  parts.  If 
the  sympathetic  be  divided  in  the  neck,  in  the  rabbit,  a  vascu- 
lar congestion  of  all  parts  of  the  head,  on  the  corresponding 
side  immediately  follows.  This  congestion  is  most  evident  in 
the  thin  and  transparent  ears,  which  on  the  affected  side 
become  very  red,  due  to  the  turgid  condition  of  the  blood- 
vessels. This  condition  lasts  for  a  considerable  time,  and 
even  for  a  longer  time  when  the  cervical  ganglion  is  ex- 
tirpated, or  a  portion  of  the  nerve  cut  out,  than  when  its  fila- 
ments have  been  simply  divided.  It  finally  disappears  when 
the  separated  filaments  have  been  re-united  and  their  func- 
tional activity  restored. 

The  vascular  congestion  thus  produced  by  the  division  of 
the  sympathetic  nerve  is  accompanied  by  three  important 
phenomena,  all  intimately  connected  with  each  othec. 

First,  the  amount  of  blood  in  a  part  is  fncreased,  and  the 
rapidity  of  its  movement  is  accelerated.  The  congestion  is 
not  due  to  venous  obstruction,  but  all  the  vessels  are  dilated, 
an  increased  amount  of  blood  passes  through  the  capillaries, 
and  returns  by  the  veins  in  greater  abundance  than  before. 

Second,  there  is  a  marked  elevation  in  the  temperature  of 
the  affected  part.  This  increase  of  temperature  may  be  felt 
by  touching  the  ear  of  the  rabbit,  and  even  the  skin  of  the 
corresponding  side  of  the  head.  Measured  by  the  thermom- 
eter, it  has  been  found  by  Bernard  to  reach,  in  some  cases. 


102  SPINAL  ADJUSTMENT 

go   or  9°   F.     It  is  due  to  the  increased  quantity  of  blood, 
which  carries  added  heat  to  the  parts. 

Third,  the  color  of  the  venous  blood  in  the  affected  part 
becomes  brighter  and  more  ruddy.  This  effect  is  also  due  to 
the  increased  rapidity  of  the  circulation.  As  the  arterial 
blood  is  deprived  of  its  oxygen  and  darkened  in  color  by  the 
changes  of  nutrition  which  usually  take  place  in  the  tissues, 
if  the  rapidity  of  the  circulation  be  suddenly  increased,  a  cer- 
tain part  of  the  blood  escapes  deoxidation,  and  the  change  in 
color,  from  arterial  to  venous,  is  incomplete.  Summed  up, 
therefore,  the  blood  returns  by  the  veins  of  the  affected  part 
in  greater  abundance,  at  a  higher  temperature,  and  of  a  more 
ruddy  color,  than  that  on  the  unaffected  side. 

Now  it  is  found  that,  if  that  portion  of  the  divided  nerve 
which  is  in  connection  with  the  affected  tissue  is  irritated  by 
electricity,  all  the  above  effects  rapidly  disappear;  the  blood- 
vessels of  the  ear  and  side  of  the  head  contract  to  their 
previous  size,  the  quantity  of  blood  circulating  through  the 
tissues  is  diminished,  the  temperature  of  the  parts  is  reduced 
to  a  corresponding  degree,  and  the  blood  in  the  veins  returns 
to  its  ordinary  dark  color. 

The  variations  in  the  rapidity  of  the  circulation  dependent 
on  the  sympathetic  were  shown  by  Bernard  in  the  following 
experiment.  The  upper  part  of  a  rabbit's  ear  is  cut  off  so 
that  the  blood  may  escape  in  jets.  The  force  and  height  of  • 
the  jets  having  been  observed,  the  sympathetic  nerve  is  then 
divided,  and  at  once  the  blood  escapes  from  the  ear  in  greater 
abundance ;  if  then  the  galvanic  current  is  applied  to  the 
proximal  end  of  the  cut  nerve,  the  escape  of  blood  gradually 
ceases ;  as  soon  as  the  galvanic  current  is  removed,  the  flow 
of  blood  again  increases.  A  similar  influence  is  exerted  by 
the  sympathetic  nerve  upon  the  circulation  in  the  limbs.  If 
the  lumbar  nerves  of  one  side  be  divided,  in  a  dog,  within  the 
spinal  canal,  paralysis  and  anaesthesia  of  the  corresponding 
limb  follow,  but  there  is  no  change  in  its  temperature  or 
vascularity.  But  if  the  lumbar  portion  of  the  sympathetic  be 
divided,  without  disturbing  the  spinal  nerves,  increased  cir- 
culation and  temperature  are  at  once  evident,  without  any 
loss  of  motion  or  sensibility.  Exsection  of  the  first  thoracic 
ganglion  produces  similar  effects  in  the  upper  extremity;  and 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  103 

these  effects  disappear  when  the  galvanic  current  is  applied 
to  the  upper  end  of  the  divided  nerve. 

The  vascularity  of  all  parts,  therefore,  as  w^ell  as  their 
functional  activity  depends  upon  the  action  of  the  nervous 
system.  The  sympathetic  nerves  accompany  the  blood-ves- 
sels to  their  minutest  ramifications.  These  sympathetic  fibres 
act  by  causing  a  contraction  of  the  muscular  coat  of  the  blood- 
vessels and  thus  regulate  the  passage  of  blood  through  them. 
These  nerves  are  termed,  accordingly,  vaso-motor  nerves,  and 
they  do  not  differ  from  the  pilo-motor  and  secretory  nerves 
except  in  the  nature  of  the  structure  in  which  they  terminate. 
They  are  of  two  kinds,  according  to  their  function,  namely : 
vaso-constrictor  and  vaso-dilator. 

Influence  on  Secretion. — Numerous  experiments  which 
have  been  made  tend  to  prove  that  special  secretory  nerves 
exist.  These  nerves  govern  the  activity  of  the  secretory 
structures  of  the  body,  assisted  by  trophic  nerves.  A  detailed 
account  of  them  is  scarcely  appropriate  in  this  place,  since 
a  thorough  understanding  of  them  can  be  obtained  by  refer- 
ence to  any  work  on  physiology. 

The  various  secretory  organs  contain  special  secreting 
cells,  which  form  the  secretion  peculiar  to  that  special  organ. 
The  products  of  secretion  are  not  derived  from  the  blood 
through  osmosis  as  was  formerly  supposed,  because  the 
secreted  material  contains  ingredients  which  are  never  found 
in  the  bood.  Thus  the  saliva  contains  ptyalin,  the  gastric 
juice  contains  pepsin,  etc.  These  characteristic  ingredients 
of  the  various  glands  are  formed  by  the  catalytic  transforma- 
tion of  their  organic  constituents;  these  new  substances 
formed  by  the  gland  cells,  together  with  the  saline  and  watery 
constituents  derived  from  the  blood  constitute  the  secreted 
fluid.  A  true  secretion,  therefore,  is  produced  only  in  its  own 
particular  gland,  and  cannot  be  formed  elsewhere,  since  the 
glandular  cells  of  that  organ  are  the  only  ones  capable  of 
producing  its  most  characteristic  ingredient. 

The  process  of  secretion  depends  upon  the  peculiar 
anatomical  and  chemical  constitution  of  the  glandular  tissue 
and  its  secreting  cells.  These  cells  have  the  property  of 
taking  from  the  blood  certain  inorganic  and  saline  substances, 
and  of  producing  by  chemical  metamorphosis  certain  peculiar 


104  SPINAL  ADJUSTMENT 

animal  matters  from  their  own  tissue.  These  substances  are 
then  mingled  together,  dissolved  in  the  watery  fluids  of  the 
secretion,  and  discharged  simultaneously  by  the  excretory 
duct. 

This  process  is  controlled  by  the  sympathetic  and  cerebro- 
spinal systems,  and  is  entirely  involuntary.  It  depends  for 
its  occurance  upon  the  excitation  of  the  secretory  centre,  by 
afferent  impulses,  which  reflexly  affect  the  fibres  which  control 
the  secretory  cells  of  a  particular  gland.  For  example,  the 
smell  of  food  reflexly  causes  a  free  flow  of  saliva ;  the  ingestion 
of  food  then  produces  the  secretion  of  gastric  juice.  A  con- 
stant flow  of  efferent  impulses,  such  as  that  which  maintains 
the  muscles  in  a  state  of  continuous  contraction,  may  also 
govern  the  secretory  activities  of  certain  glands,  as  those 
having  an  internal  secretion,  namely  the  thyroid,  spleen,  etc. 

Any  interference  with  the  conductivity  of  the  sympathetic 
nerves  changes  the  character  of  the  secretion  and  interferes 
with  the  functional  activity  of  the  organ  which  depends  for 
its  action  upon  the  materials  which  it  secretes.  The  sym- 
pathetic nerves  influence  secretion  by  their  vaso-dilatory 
action  upon  the  blood,  and  also  by  their  trophic  action.  Thus, 
when  the  sympathetic  fibres  are  stimulated,  previous  to  stimu- 
lation of  the  cerebral  fibres  controlling  the  parotid  gland  of 
a  dog,  a  rich  salivary  secretion  is  obtained,  while  stimulation 
of  the  cerebral  fibres  alone  gives  an  abundant  thin  and  watery 
secretion.  The  sympathetic  system  alone  does  not  govern 
secretion,  but  the  part  which  it  takes  in  this  function  is  ex- 
ceedingly important,  as  demonstrated  by  clinical  results  ob- 
tained in  the  various  conditions  dependent  upon  faulty  secre- 
tion. 

Influence  on  Excretion. — In  order  to  understand  the  nature 
of  this  process  we  must  bear  in  mind  that  all  the  component 
parts  of  a  living  organism  are  in  a  state  of  constant  change. 
Every  animal  absorbs  constantly  substances  which  it  con- 
verts into  the  natural  ingredients  of  the  organized  tissues.  At 
the  same  time  there  goes  on  in  the  same  tissues  an  incessant 
process  of  waste  and  decomposition.  The  products  of  this  de- 
structive process  are  destined  to  be  discharged  from  the  body 
and  are  known  as  excrementitious  substances.  These  sub- 
stances are  conveyed  by  the  blood  to  certain  excretory  organs, 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  103 

which  discharge  them  from  the  body.  This  entire  process 
is  known  as  excretion. 

The  importance  of  this  process  to  the  maintenance  of  life 
is  readily  shown  by  the  injurious  effects  which  follow  upon 
its  disturbance.  If  the  discharge  of  the  excrementitious  sub- 
stances be  in  any  way  impeded  or  stopped,  they  accumulate 
in  the  blood  and  tissues.  In  consequence  of  this  retention 
and  accumulation,  they  become  poisonous,  and  rapidly  pro- 
duce a  disturbance  of  the  vital  functions.  Their  influence  is 
particularly  exerted  upon  the  nervous  system,  producing  vari- 
ous forms  of  irritability,  disturbance  of  the  special  senses, 
deliriums,  insensibility,  coma,  and  even  death. 

The  most  important  avenues  for  the  discharge  from  the 
body  of  these  poisonous  substances  are  the  bowels,  kidneys, 
skin,  and  lungs.  The  nerve  supply,  both  cerebro-spinal  and 
sympathetic,  of  these  organs  will  be  given  in  detail  farther 
on.  Suffice  it  to  say  at  this  point  that  derangement  of  the 
nerve-supply  to  these  eliminative  organs  is  followed  by  a 
train  of  diseased  conditions,  the  number  and  seriousness  of 
which  is  stupendous.  These  conditions  have  as  their  basis 
that  very  common  condition  known  as  autointoxication,  and 
it  is  scarcely  necessary  to  go  into  detail  regarding  the  vast 
number  of  affections  of  diverse  kinds  which  may  be  traced  to 
a  perverted  function  of  the  excretory  organs.  What  a  variety 
of  conditions  result  from  constipation,  for  example,  is  well 
known ;  again,  the  great  number  of  diseases  resulting  from 
faulty  action  of  the  kidneys  needs  no  explanation;  then,  the 
train  of  diseases  following  depleted  excretory  activity  of  the 
skin  are  very  well  understood ;  lastly,  deficient  oxygenation 
of  the  blood  as  produced  by  respiratory  incapacity,  is  also 
well  known  to  be  the  cause  of  many  and  varied  disorders. 

The  importance  of  proper  excretory  action  of  the  parts  to 
which  this  function  is  peculiar  assumes  tremendous  propor- 
tions. These  functions  are  intimately  dependent  upon  a  free 
and  untrammeled  action  of  the  nervous  system.  Any  obstruc- 
tion to  the  passage  of  the  efferent  impulses  along  the  cerebro- 
spinal and  sympathetic  nerve-fibres  at  once  produces  deficient 
excretion  from  the  organs  which  are  deprived  of  these  nerve- 
impulses.  The  profuse  perspiration  following  stimulation  of 
the  cervical  sympathetic  ganglia  illustrates  the  marked  influ- 


106  SPINAL  ADJUSTMENT 

ence  it  has  upon  the  action  of  the  excretory  apparatus  of  the 
skin.  Like  results  follow  adjustment  to  their  proper  posi- 
tion of  displaced  vertebrae  when  the  other  excretory  organs 
are  affected. 

Influence  on  Other  Existing  Action. — All  the  active  tissues 
of  the  body  may  be  influenced  by  their  nerves  in  two  opposite 
ways.  That  is,  stimulation  may  increase  or  decrease  their 
activity.  Thus  the  functional  activity  of  the  glands,  nerve- 
centres  and  muscles  can  be  so  varied.  The  nerves  which  cause 
increased  action  are  known  as  augmentor,  while  those  that 
produce  decreased  action  are  called  inhibitory  nerves.  They 
are  distinct  from  each  other  anatomically,  except  in  the 
central  nervous  system. 

It  is  questionable  whether  there  exists  a  special  class  of 
inhibitory  nerves  but  there  must  certainly  be  a  different 
dendritic  pathway  for  the  impulses  causing  inhibition.  What- 
ever nerves  do  subserve  this  function,  their  importance  is 
manifest ;  for  they  control  the  balanced  activity  of  all  parts. 
Since  their  action  is  involuntary,  it  may  be  safely  assumed 
that  it  is  the  peculiar  office  of  the  sympathetic  system  to 
influence  existing  action,  in  connection  with  the  cerebro-spinal 
nerves  to  the  part  involved. 

The  general  bearing  of  these  facts  is  of  the  greatest  im- 
portance. As  has  been  pointed  out  by  Hughlings-Jackson, 
damage  of  any  sort  to  a  portion  of  the  nervous  system  may, 
in  the  simplest  case,  decrease  the  activity  of  the  group  of 
neurons  controlled  by  the  damaged  part  by  cutting  off  the 
stimulating  impulses  from  them.  On  the  other  hand,  a  fact 
which  is  often  overlooked,  it  may  cause  them  to  become 
abnormally  active,  by  the  stoppage  of  some  impulses  which 
exert  an  inhibitory  effect. 

Influence  on  the  Special  Senses. — In  the  cranium,  the  sym- 
pathetic system  has  a  very  close  and  important  connection 
with  the  exercise  of  the  special  senses.  This  is  especially  well 
illustrated  in  the  case  of  the  eye,  by  its  influence  on  the 
expansion  and  contraction  of  the  pupil. 

The  ophthalmic  ganglion  sends  off  a  number  of  ciliary 
nerves,  which  are  distributed  to  the  iris.  As  we  have  seen, 
it  is  connected  with  the  remaining  sympathetic  ganglia  in  the 
head,  and  receives,  beside,  a  sensory  root  from  the  ophthalmic 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  107 

branch  of  the  fifth  cranial  nerve,  and  a  motor  root  from  the 
third  cranial  nerve.  The  reflex  action  by  which  the  pupil 
contracts  when  a  strong  light  falls  upon  the  retina,  and  ex- 
pands when  the  amount  of  light  is  diminished,  takes  place, 
accordingly,  through  this  ganglion.  The  impression  on  the 
retina  is  conveyed  by  the  optic  nerve  to  the  tubercula  quad- 
rigemina,  and  then  reflected  outward  by  the  motor  oculi.  The 
efferent  impulse  is  not  transmitted  directly  to  the  iris  by  the 
last-named  nerve,  but  passes  first  to  the  ophthalmic  ganglion, 
and  thence  to  its  destination,  by  the  ciliary  nerves. 

The  reflex  movements  of  the  iris  are  somewhat  sluggish, 
which  indicates  the  intervention  of  the  sympathetic.  The 
changes  in  the  size  of  the  pupil  do  not  occur  immediately  with 
the  varying  amounts  of  light,  but  require  an  appreciable 
interval  of  time.  For  example,  if  we  pass  from  a  dark  apart- 
ment into  the  brilliant  sunshine,  we  are  at  once  conscious 
of  a  painful  sensation  in  the  eyes,  which  lasts  for  a  consider- 
able time;  this  results  from  the  inability  of  the  pupil  to  con- 
tract with  sufficient  rapidity  to  shut  out  the  excessive  amount 
of  light. 

The  reflex  movements  of  the  iris  derive  their  original 
stimulus  from  the  motor  oculi  nerve.  This  nerve,  however, 
will  not  act  without  the  assistance  of  the  sympathetic.  Any 
break  in  the  connection  of  the  sympathetic  with  the  motor 
oculi,  therefore,  prevents  the  latter  from  functionating.  Thus 
if  the  sympathetic  in  the  neck,  in  a  cat,  be  divided,  the  pupil 
of  the  corresponding  eye  becomes  strongly  and  permanently 
contracted.  In  addition  to  this,  the  upper  and  lower  eyelids 
and  the  nictitating  membrane  are  also  drawn  partially  over 
the  cornea,  and  assist  in  excluding  the  light.  Secondly,  divi- 
sion of  the  motor  oculi,  alone,  in  the  cat,  does  not  cause  dila- 
tation of  the  pupil.  The  fact  that  the  motor  oculi  and  the 
facial  nerves  control  the  external  muscles  of  the  eye,  ear,  and 
nose,  but  that  contraction  of  those  muscles  follows  division 
of  the  sympathetic,  shows  the  intimate  dependence  of  these 
cranial  nerves  upon  the  integrity  of  the  sympathetic. 

Similarly,  in  spasms  of  the  eyelids,  no  actual  lesion  of  the 
motor  oculi  can  be  found,  but  irritation  of  the  superior  cervical 
ganglion  of  the  gangliated  cord  is  present,  and  is  responsible 
for  this  condition.     It  is  for  this  reason  that  adjustment  of  a 


108  SPINAL  ADJUSTMENT 

displaced  cervical  vertebra,  especially  the  fourth,  or  one  of 
the  upper  dorsal  region,  at  once  stops  such  spasms. 

In  the  olfactory  apparatus,  the  external  muscles,  namely 
the  compressors  and  elevators  of  the  alae  nasi,  are  supplied 
by  filaments  from  the  facial  nerve.  Their  action  serves  to  per- 
mit the  entrance  of  odoriferous  particles  when  desirable,  and 
to  exclude  those  which  are  not  desired.  The  deep  muscles, 
namely  the  levators  and  depressors  of  the  velum  palati,  and 
the  azygos  uvulae,  are  supplied  by  the  spheno-palatine  gang- 
lion, and  accomplish  a  similar  purpose  with  the  external 
muscles;  they  tend  to  close  the  posterior  nares,  and  their 
action  is  involuntary. 

The  auditory  apparatus  has  two  similar  sets  of  muscles, 
similarly  supplied.  The  external  muscles  are  supplied  by 
branches  from  the  facial  nerve,  and  their  action  is  voluntary, 
namely  movement  of  the  external  ear.  The  deep-seated  set 
are  the  muscles  of  the  middle  ear.  It  must  be  remembered 
that  sounds  are  transmitted  from  the  external  to  the  middle 
ear  through  the  tympanic  membrane,  which  vibrates,  like  the 
head  of  a  drum,  on  receiving  sonorous  impulses  from  without. 
Accordingly  the  ear-drum  may  be  made  more  or  less  sensi- 
tive to  sonorous  impressions  by  varying  its  degree  of  tension 
or  relaxation.  This  condition,  as  we  well  know,  is  regulated 
by  the  action  of  the  two  muscles  of  the  middle  ear,  viz.,  the 
tensor  tympani  and  the  stapedius.  The  tensor  tympani  is  sup- 
plied by  filaments  from  the  otic  ganglion  of  the  sympathetic. 
By  its  contraction  the  membrane  is  rendered  tense,  and  on 
the  relaxation  of  this  muscle,  the  mem"brane  returns  to  its 
former  condition.  This  action  is  involuntary.  But  the 
stapedius  is  supplied  by  a  minute  filament  from  the  facial 
nerve,  and  it  is  probable  that  this  arrangement  enables  us 
to  a  degree  of  voluntary  action,  as  in  listening  intently  to 
distant  or  faint  sounds. 

In  all  the  above  instances,  the  reflex  action  of  the  drum 
which  takes  place  originates  from  a  sensation  which  is  con- 
veyed inward  to  the  cerebro-spinal  centres,  and  is  then  trans- 
mitted outward  to  its  destination  through  the  medium  of  one 
of  the  sympathetic  ganglia. 

Influence  on  Reflex  Action. — The  influence  of  the  sympa- 
thetic   system    on    reflex    actions    is    exceedingly    important. 


PHYSIOLOGY  OF  SYMPATHETIC  SYSTEM  109 

There  are  three  kinds  of  reflex  action,  taking  place  wholly 
or  partly  through  the  sympathetic  system,  which  may  be 
observed  to  occur  in  the  living  body. 

First,  reflex  actions  taking  place  from  the  internal  organs, 
through  the  sympathetic  and  cerebro-spinal  systems,  to  the 
voluntary  muscles  and  the  sensory  surfaces.  Thus,  the  con- 
vulsions of  young  children  are  often  due  to  the  presence  of 
undigested  food  in  the  intestinal  canal.  Attacks  of  indiges- 
tion often  produce  temporary  amaurosis,  double  vision,  strabis- 
mus, and  even  hemiplegia.  Nausea  and  vomiting  are  promi- 
nent symptoms  of  the  second  and  third  months  of  pregnancy, 
induced  reflexly  by  the  peculiar  condition  of  the  uterine 
mucous  membrane. 

Secondly,  reflex  actions  taking  place  from  the  sensory 
surfaces,  through  the  sympathetic  and  cerebro-spinal  systems, 
to  the  involuntary  muscles  and  secreting  glands.  Thus  ex- 
posure to  cold  and  wet  will  often  cause  diarrhea.  Mental  and 
moral  impressions,  conveyed  through  the  special  senses,  will 
afifect  the  action  of  the  heart,  and  disturb  the  processes  of 
digestion  and  secretion.  Terror,  or  intense  interest  in  some- 
thing, will  cause  the  pupil  to  become  dilated.  Disagreeable 
sights  or  odors  may  bring  on  or  stop  menstruation,  or  induce 
premature  labor. 

Thirdly,  reflex  actions  taking  place  through  the  sympa- 
thetic system,  from  one  part  of  the  internal  organs  to  another. 
Thus,  the  contact  of  food  with  the  mucous  membrane  of  the 
small  intestines  excites  a  peristaltic  movement  of  their  muscu- 
lar walls.  The  mutual  action  of  the  digestive,  urinary,  and 
internal  generative  organs  upon  each  other  takes  place 
through  the  medium  of  the  sympathetic  ganglia  and  their 
nerves.  The  variations  of  the  capillary  circulation  in  the 
abdominal  viscera,  corresponding  with  their  state  of  activity 
or  rest,  are  produced  by  the  same  mechanism. 

These  phenomena  are  not  accompanied  by  any  conscious- 
ness on  the  part  of  the  individual,  nor  by  any  apparent  inter- 
vention of  the  cerebro-spinal  system. 

Influence  on  the  Organs. — The  sympathetic  system  has  an 
action  entirely  separate  from  any  connection  with  the  cerebro- 
spinal system  in  those  organs  in  which  terminal  ganglia  are 
located.     For  example,  the  influence  of  the  cardiac  sympa- 


no  SPINAL  ADJUSTMENT 

thetic  nerves  on  the  heart,  and  of  the  splanchnics  on  the 
stomach.  Other  instances  of  this  influence  also  exist,  and  will 
be  considered  at  proper  length  in  the  section  dealing  with 
the  nerve-supply  of  the  various  organs  of  the  body. 


SECTION  THREE 
Innervation 


CHAPTER  I 

The  Innervation  of  the  Structures  of  the  Cranium,  Face  and 

Neck 

A  ready  familiarity  with  the  nerve-supply  of  every  sys- 
tem, organ,  and  part  of  the  body  is  essential  to  a  thorough 
understanding  of  the  underlying  principles  of  spinal  adjust- 
ment. It  is  also  necessary  from  the  view-point  of  diagnosis 
and  treatment  of  diseased  conditions  by  these  methods. 

The  connection  between  the  spinal  nerves  and  those  of  the 
sympathetic  system  has  already  been  explained,  as  well  as 
their  connection  with  the  cranial  nerves.  What  remains  to  be 
considered,  therefore,  is  the  connection  between  the  nerves 
of  each  spinal  segment  and  the  respective  organs  which  they 
supply. 

Since  the  nervous  system  is  continuous  throughout  its 
entire  course,  it  follows  that  each  system,  organ,  and  part  of 
the  body  derives  its  nerve-supply  through  the  medium  of  the 
spinal  cord  and  the  spinal  nerves  which,  given  ofif  from  it, 
emerge  through  the  intervertebral  foramina.  It  is  at  this 
point  that  the  reflex  arc  is  situated  by  which  the  body  is  kept 
in  harmony  with  the  external  influences  which  afifect  it.  Any 
interference  with  the  proper  action  of  this  arc  will  cause 
disharmony  and  disease. 

As  has  been  previously  shown,  vertebral  subluxations  will, 
by  destroying  the  conductivity  of  the  nerves  at  this  point, 
deprive  the  corresponding  parts  of  the  body  of  the  nerve- 
impulses  necessary  to  their  functional  activity  and  organic 
integrity.  It  is  for  this  reason  that  we  will  consider  in  this 
connection  the  parts  of  the  body  supplied  by  the  nerve  from 
each  segment  of  the  spine,  and  all  its  ramifications, 

111 


112 


SPINAL  ADJUSTMENT 


fikin  ofF<»,ce   a,/ttl  HecK 


Fig.  11. 

Parts  Influenced  by  the  First 
Cervical   Nerve. 


CRANIUM,  FACE  AND  NECK  113 

The  Innervation  of  the  Scalp. — The  innervation  of  the 
scalp  is  derived  from  the  following  nerves : 

1.  The  posterior  auricular,  which  is  a  branch  of  the  facial 
which  communicates  with  the  sympathetic  on  the  middle 
meningeal  artery  by  the  external  superficial  petrosal  nerve ; 
this  in  turn  communicates  with  the  superior  cervical  ganglion. 

2.  The  great  auricular  nerves,  the  branches  of  origin  of 
which  communicate  with  the  second  and  third  pairs  of  cervical 
nerves,  and  send  branches  to  the  region  of  the  scalp  about 
the  ears. 

3.  The  suboccipital  nerves,  which  are  the  first  pair  of 
spinal  nerves  and  emerge  from  the  vertebral  canal  through 
the  posterior  condyloid  notches  between  the  occipital  bone 
and  the  posterior  arch  of  the  atlas  on  each  side.  These  nerves 
supply  a  greater  portion  of  the  scalp  than  any  others,  sending 
branches  to  the  occipital  region,  the  vertex  and  the  forehead. 

4.  The  occipitalis  major  nerve,  which  is  the  internal  branch 
of  the  posterior  division  of  the  second  cervical  nerve.  In  its 
upward  course  it  is  joined  by  a  filament  from  the  posterior 
division  of  the  third  cervical  nerve,  and  on  the  back  part 
of  the  head  divides  into  two  branches  which  supply  the 
integument  of  the  scalp  as  far  forward  as  the  vertex. 

5.  The  occipitalis  minor,  which  arises  from  the  second 
cervical  nerve,  and  sometimes  also  the  third.  It  extends  up- 
ward along  the  side  of  the  back  of  the  head,  and  supplies  the 
integument  behind  the  ear.  Here  it  communicates  with  the 
occipitalis  major,  the  great  auricular,  and  the  posterior  auri- 
cular branch  of  the  facial.  It  gives  off  an  auricular  branch 
which  supplies  the  integument  of  the  upper  and  back  part 
of  the  auricle. 

6.  The  third  occipital  nerve,  which  arises  from  the  internal 
or  cutaneous  branch  of  the  posterior  division  of  the  third 
cervical  nerve,  and  which  supplies  the  skin  on  the  lower  and 
back  part  of  the  head. 

7.  The  fourth  pair  of  cervical  nerves  also  influence  the 
scalp,  by  reason  of  their  control  of  the  circulation.  They 
form  the  greater  part  of  the  phrenic  nerve  which  innervates 
the  diaphragm  and  lungs,  and  governs  their  movements.  In 
this  manner,  the  middle  cervical  nerves  by  affecting  the  cir- 
culation of  the  thorax,  influence  indirectly  the  circulation  of 


114 


SPINAL  ADJUSTMENT 


Fig.  12. 


Parts  Influenced  by  the  Second 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  115 

the  head.  Failure  of  proper  action  of  the  diaphragm  and 
lungs,  by  diminishing  the  blood  in  those  parts,  will  result  in 
an  excess  of  blood  in  the  brain.  On  the  contrary,  a  free 
action  of  the  diaphragm  and  lungs  will  relieve  congestion  of 
the  brain. 

8.  The  scalp  is  also  indirectly  affected  by  the  spinal  seg- 
ments down  to  the  tenth  segment.  This  is  due  to  the  influ- 
ence of  these  nerves  upon  the  glands  of  the  skin.  All  the 
nerves,  and  especially  the  tenth  dorsal,  affect  the  skin  of  the 
corresponding  region  of  the  body. 

The  Innervation  of  the  Face  and  Neck. — The  innervation 
of  the  integument  of  the  face  and  neck  is  derived  principally 
from  the  cervical  plexus  and  the  cranial  nerves.  The  dorsal 
nerves  also  indirectly  influence  these  parts  by  their  con- 
trol of  the  circulation.  Specifically  the  face  and  neck  are 
innervated  by  the  following  nerves : 

1.  The  trigeminal  nerves,  through  the  ophthalmic,  supe- 
rior maxillary,  and  inferior  maxillary  nerves  supply  the  integ- 
ument of  the  face  and  the  deeper  structures.  The  Gasserian 
ganglion  from  which  the  three  branches  of  this  nerve  are 
derived  communicates  with  the  carotid  plexus  of  the  sympa- 
thetic. The  ophthalmic  nerve  communicates  with  the  cavern- 
ous plexus  of  the  sympathetic,  the  third  and  sixth  nerves  and 
occasionally  with  the  fourth  nerve.  By  means  of  this  con- 
nection with  the  superior  cervical  ganglion  of  the  sympathetic 
the  structures  supplied  by  the  trigeminal  nerve  may  be 
influenced  by  adjustment  of  the  upper  four  cervical  vertebrae. 

2.  The  facial  nerves,  which  supply  the  remaining  portions 
of  the  skin  of  the  face  and  the  muscles  of  expression.  This 
nerve  communicates,  through  the  geniculate  ganglion,  with 
the  sympathetic  on  the  middle  meningeal  artery  by  the  ex- 
ternal superficial  petrosal  nerve.  The  structures  which  it 
supplies  are  thus  also  influenced  by  adjustment  of  the  upper 
four  cervical  vertebrae. 

3.  The  first,  second,  third,  and  fourth  cervical  nerves, 
which  give  off  branches  to  form  the  cervical  plexus  which  is 
distributed  to  the  integument  and  muscles  of  the  face  and 
neck. 

4.  The  first  six  thoracic  nerves  send  white  rami  communi- 
cantes  to  the  superior  cervical  ganglion  of  the  sympathetic, 


116 


SPINAL  ADJUSTMENT 


Fig.  13. 

Tarts  Influenced  by  the  Third 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  117 

which  through  its  various  communications  influences  the 
integument  of  the  face  and  neck. 

5.  The  tenth  thoracic  nerves  by  reason  of  their  influence 
upon  the  function  of  the  skin,  affect  the  integument  of  the 
face  and  neck.  These  nerves  also  have  a  decided  influence 
upon  the  action  of  the  kidneys,  and  by  increasing  the  elimina- 
tion of  fluids  through  this  channel,  will  diminish  the 
elimination  through  the  skin. 

The  Innervation  of  the  Brain. — Various  nerves  are  dis- 
tributed to  the  substance  of  the  brain  and  its  meninges,  and 
govern  its  function,  metabolism  and  the  circulation  of  the 
blood  through  it.  ■  The  brain  is  accordingly  innervated  by 
the  following  nerves : 

1.  The  dura  mater  is  supplied  by  filaments  from  the  Gas- 
serian  ganglion,  from  the  ophthalmic,  superior  maxillary, 
inferior  maxillary,  vagus,  and  hypoglossal  nerves,  and  from 
the  sympathetic. 

The  arachnoid  is  supplied  by  a  rich  plexus  derived  from 
the  motor  division  of  the  fifth,  the  facial,  and  the  spinal 
accessory  nerves. 

The  pia  mater  is  supplied  by  branches  from  the  sympa- 
thetic, and  from  the  third,  fifth,  sixth,  seventh,  ninth,  tenth, 
and  eleventh  cranial  nerves. 

Since  the  above  nerves  all  communicate  with  the  superior 
cervical  ganglion  of  the  gangliated  cord,  and  this  in  turn 
with  the  upper  four  spinal  nerves,  subluxations  of  the  upper 
four  cervical  vertebrae  will  affect  the  meninges  of  the  brain. 

2.  The  fourth  cervical  nerves  by  their  influence  upon  the 
circulation  of  the  blood  in  the  thorax  indirectly  influence  the 
cerebral  blood-supply,  and  are  therefore  considered  as  having 
an  influence  upon  the  brain. 

3.  The  suboccipital  nerves  affect  the  meninges  by  giving 
off  branches  which  assist  in  the  formation  of  the  recurrent 
nerve  to  the  tentorium. 

4.  The  lower  cervical  nerves,  by  their  influence  upon  the 
respiratory  movements,  indirectly  influence  the  circulation  in 
the  brain.  The  expansion  of  the  thorax  in  inspiration  in- 
creases the  blood-supply  to  this  region,  and  thus  decreases  the 
blood-supply    to   the    cranium.      Deficient    respiratory   move- 


118 


SPINAL  ADJUSTMENT 


g.  14. 


I'aits  Influenced  by  the  Fourth 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  119 

meats  diminish  the  blood-supply  to  the  thorax,  and  therefore 
cause  a  congestion  in  the  brain. 

5.  The  upper  thoracic  nerves,  by  sending  white  rami 
communicantes  to  the  superior  cervical  ganglion  which  com- 
municates with  all  the  cranial  nerves,  have  an  influence  upon 
the  functional  activity  of  the  brain.  From  the  superior  cervi- 
cal ganglion  impulses  are  transmitted  by  the  gray  rami  to 
the  cranial  nerves,  the  rami  then  accompanying  the  cranial 
nerves  from  their  origin  outward  to  their  entire  distribution. 

6.  The  lower  thoracic  nerves,  by  reason  of  their  communi- 
cation with  the  phrenic  nerves,  have  an  indirect,  but  decided, 
influence  upon  the  circulation  of  the  brain. 

The  Innervation  of  the  Eye. — The  innervation  of  the  eye 
both  direct  and  indirect,  is  of  the  greatest  importance,  since 
clinical  experience  bears  out  the  fact  that,  although,  anatom- 
ically the  connection  between  certain  spinal  nerves  with  the 
optic  nerve  cannot  be  exactly  demonstrated,  yet  their  influ- 
ence on  the  functional  activity  of  the  structures  of  the  orbit 
cannot  be  denied.  The  eyes  are  innervated  by  the  following 
nerves : 

1.  The  optic  nerves,  which  pass  directly  from  the  cortical 
surface  of  the  occipital  lobe  of  the  cerebrum  to  the  retina  of 
the  eye,  have  a  direct  and  decided  influence  upon  the  eye. 
These  nerves,  from  their  mode  of  development  and  their 
structure,  must  be  considered  as  direct  prolongations  of  the 
brain  substance,  rather  than  as  an  ordinary  cerebrospinal 
nerve.  As  the  optic  nerves  pass  from  the  brain  they  receive 
sheaths  from  the  three  cerebral  membranes — a  perineural 
sheath  from  the  pia  mater,  an  intermediate  sheath  from  the 
arachnoid,  and  an  outer  sheath  from  the  dura  mater,  which 
is  also  connected  with  the  periosteum  as  it  passes  through 
the  optic  foramen. 

2.  The  suboccipital  nerves,  by  communicating  with,  and 
assisting  in  the  formation  of  the  recurrent  nerve  to  the  tento- 
rium, influence  the  nutrition  of  the  cortical  surfaces  of  the 
occipital  lobes,  and  consequently  of  the  optic  nerves. 

3.  The  fourth  cervical  nerves  have  the  most  marked  influ- 
ence upon  the  function  of  the  optic  nerves,  and  also  influence 
the  contraction  and  dilatation  of  the  pupil.  Subluxations 
affecting  these  nerves  have  been  known  to  result  in  loss  of 


120 


SPINAL  ADJUSTMENT 


Fig.   15. 

I'arts  lufliicncod  by  the  Fifth 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  121 

vision,  and  cases  are  on  record  where  their  adjustment  has 
restored  vision. 

4.  The  first,  second  and  third  dorsal  nerves  have  an  influ- 
ence on  the  action  of  the  ciHary  muscles  of  the  eye,  by  reason 
of  their  communication  with  the  ciliary  nerves.  Their  im- 
pingement may  result  in  failure  of  the  power  of  accommo- 
dation of  the  eye,  and  thus  cause  disturbances  of  vision. 
Spasms  of  the  eye-lids  may  be  relieved  instantly  by  adjust- 
ment of  the  upper  thoracic  vertebrae. 

5.  The  fifth  pair  of  dorsal  spinal  nerves  influence  the  eye- 
balls by  reason  of  their  communication  with  the  superior 
cervical  ganglion,  which  communicates  with  the  cranial 
nerves.  This  connection  is  established  by  the  communication 
of  the  carotid  plexus  with  the  Gasserian  ganglion,  and  with 
the  sixth  nerve;  and  of  the  cavernous  plexus  with  the  third, 
the  fourth,  the  ophthalmic  division  of  the  fifth,  the  sixth, 
and  the  ophthalmic  ganglion.  In  this  manner  there  is  a  direct 
communication  of  the  fifth  dorsal  spinal  nerves  with  the  • 
nerves  to  the  eye-ball,  and  adjustment  of  the  fifth  dorsal 
vertebra  relieves  many  abnormal  conditions  of  the  eye. 

6.  The  tenth  pair  of  dorsal  spinal  nerves  have  an  influence 
upon  the  eyes.  This  has  been  rather  obscure  anatomically, 
but  clinical  evidence  bears  out  the  connection.  We  know 
that  the  tenth  dorsal  nerves  markedly  influence  the  kidneys, 
and  clinically  we  very  often  meet  with  visual  troubles  in 
various  diseases  of  the  kidneys.  The  only  connection  that 
exists  between  the  tenth  pair  of  thoracic  nerves  with  the 
optic  nerves  is  through  the  communication  of  the  former 
with  the  terminal  fibres  of  the  phrenic,  which  in  turn  is  derived 
partly  from  the  fourth  cervical  nerve,  which  we  have  seen 
has  so  powerful  an  influence  upon  vision. 

7.  The  first  and  second  lumbar  nerves  also  have  a  some- 
what obscure  yet  decided  influence  upon  the  eyes.  The 
reader  must  constantly  bear  in  mind  that  clinical  phenomena 
are  very  often  met  with  for  which  there  is  no  positive  ex- 
planation, yet  which  are  sufficient  to  prove  that  a  connection 
exists  between  certain  nerves,  even  though  they  cannot  be 
traced  anatomically. 

The  Innervation  of  the  Ear. — The  innervation  of  the  ear  is 
derived  from  the  following  ner^^es : 


122 


SPINAL  ADJUSTMENT 


Parts  Influenced  by  the  Sixth 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  123 

1.  The  auditory  nerves,  which  receives  a  branch  from  the 
geniculate  ganglion,  which  communicates  with  the  superior 
cervical  ganglion  through  the  external  petrosal  nerve.  It 
also  connects  with  the  upper  thoracic  spinal  nerves  through 
the  connection  of  the  continuous  ascending  fibres  of  white 
rami  communicantes  with  the  superior  cervical  ganglion. 
Hence  it  is  that  the  upper  cervical  and  upper  dorsal  segments 
influence  to  such  a  marked  degree  the  ear. 

2.  The  first  four  cervical  spinal  nerves  unite  with  and 
influence  the  ganglia  which  supply  the  auditory  apparatus. 
Through  the  medium  of  the  recurrent  nerve  to  the  tentorium 
they  also  afifect  the  circulation  of  the  brain,  and  consequently 
influence  also  the  auditory  centers  in  the  cerebrum. 

3.  The  upper  five  pairs  of  dorsal  spinal  nerves  influence 
the  ear  by  reason  of  their  connection  with  the  superior  cervi- 
cal ganglion.  The  superior  cervical  ganglion  communicates 
with  the  eighth  cranial  nerve,  and  for  this  reason  subluxations 
in  the  upper  cervical  or  upper  dorsal  region  produce  disturb- 
ances in  reference  to  the  ear.  The  test  for  determining 
whether  deafness  is  due  to  a  lesion  of  the  auditory  nerve 
itself  or  to  a  lesion  of  the  auditory  apparatus  is  to  place  a 
vibrating  tuning  fork  on  the  head ;  in  cases  where  the  auditory 
apparatus  is  at  fault  the  vibrations  will  be  heard,  but  not 
when  there  is  a  lesion  of  the  auditory  nerve.  A  serious  lesion 
of  the  auditory  nerve  proper  necessarily  produces  permanent 
deafness,  but  functional  disturbances  due  to  subluxations  in 
the  upper  cervical  or  upper  dorsal  regions,  as  well  as  disturb- 
ances of  the  auditory  apparatus  respond  very  readily  to  spinal 
adjustment. 

The  Innervation  of  the  Nose. — The  innervation  of  the  nasal 
chambers  is  derived  from  the  following  nerves : 

1.  The  olfactory  nerve,  the  special  nerve  of  the  sense  of 
smell,  is  distributed  to  the  olfactory  region  of  the  nasal 
cavities.  This  nerve  communicates  with  the  superior  cervical 
ganglion  of  the  sympathetic,  and  is  therefore  influenced  by 
lesions  in  the  upper  cervical  region. 

2.  The  nasal  nerve,  a  branch  of  the  ophthalmic  division  of 
the  fifth  cranial  ner\'e.  distributes  filaments  to  the  fore  part 
of  the  septum  and  the  outer  wall  of  the  nasal  fossae.  This 
nerve  is  also  influenced  by  lesions  of  the  upper  four  cervical 


124 


SPINAL  ADJUSTMENT 


Fig.  17. 


Tarts  luHueiiced  by  the  iSeveuth 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  125 

vertebrae  since  the  Gasserian  ganglion  communicates  with 
the  carotid  plexus  of  the  superior  cervical  ganglion,  while 
the  ophthalmic  division  of  the  fifth  cranial  nerve  communicates 
with  the  cavernous  plexus. 

3.  The  vidian  nerve,  which  supplies  the  upper  and  back 
part  of  the  septum  and  the  superior  spongy  bone,  communi- 
cates through  the  superior  cervical  ganglion  with  the  upper 
four  spinal  nerves. 

4.  The  naso-palatine  nerve,  a  branch  of  the  superior  divi- 
sion of  the  fifth  cranial  nerve,  communicates  with  the  superior 
cervical  ganglion  through  the  connection  of  the  Gasserian 
ganglion  with  the  carotid  plexus. 

5.  The  third  cervical  spinal  nerve,  by  its  connection  with 
the  superior  cervical  ganglion,  communicates  with  the  fifth 
cranial  nerve,  and  thus  becomes  the  most  direct  source  of 
innervation  to  the  nose. 

6.  The  fourth  cervical  spinal  nerve,  for  the  same  reason 
that  the  third  spinal  nerve  afifects  the  nose,  also  influences  the 
nasal  cavities  directly. 

7.  The  fourth  and  fifth  dorsal  spinal  nerves,  by  their  con- 
nection wnth  the  superior  cervical  ganglion  of  the  sympathetic, 
have  an  indirect  influence  upon  the  nasal  cavities. 

8.  The  tenth  pair  of  thoracic  spinal  nerves  have  a  very 
great  influence  on  the  action  of  the  skin.  A  subluxation  caus- 
ing interference  wath  these  nerves  will,  therefore,  markedly 
aflfect  the  Schneiderian  membrane  of  the  nose. 

The  Innervation  of  the  Pharynx. — The  innervation  of  the 
pharynx  is  derived  from  the  following  nerves : 

1.  The  first  and  second  cervical  spinal  nerves,  by  reason 
of  their  connection  with  the  vagus,  have  a  direct  influence 
upon  the  pharynx. 

2.  The  fifth,  sixth  and  seventh  cervical  spinal  nerves  have 
a  direct  influence  on  the  pharynx. 

3.  The  upper  dorsal  spinal  nerves  have  an  indirect  influ- 
ence upon  the  pharynx,  through  their  connection  with  the 
superior  cervical  ganglion. 

4.  The  pharyngeal  nerves,  which  are  one  of  the  internal 
branches  of  the  superior  cervical  ganglion  of  the  sympathetic, 
pass  to  the  side  of  the  pharynx,  where  they  join  with  branches 
from    the   glosso-pharyngeal,   vagus,   and    external   laryngeal 


126 


SPINAL  ADJUSTMENT 


Fig.  18. 


Parts  Influenced  by  the  Eighth 
Cervical  Nerve. 


CRANIUM,  FACE  AND  NECK  127 

nerves  to  form  the  pharyngeal  plexus.  The  superior  cervical 
ganglion  communicating  with  the  upper  four  spinal  nerves, 
any  impingement  of  these  nerves  will  interfere  with  the 
proper  innervation  of  the  larynx,  which  is  very  quickly 
corrected  by  adjustment  of  the  displaced  vertebrae. 

5.  The  pharyngeal  branch  from  Meckel's  ganglion,  which 
communicates  with  the  superior  cervical  ganglion  of  the 
sympathetic,  also  influences  the  pharynx. 

6.  The  pharyngeal  branches  of  the  glosso-pharyngeal 
nerve  unite  with  the  pharyngeal  branches  of  the  vagus  and 
sympathetic  nerves  to  form  the  pharyngeal  plexus,  branches 
from  which  perforate  the  muscular  coat  of  the  pharynx  to 
supply  the  muscles  and  mucous  membrane. 

7.  The  pharyngeal  branch  of  the  vagus,  the  principal 
motor  nerve  of  the  pharynx,  arises  from  the  inferior  ganglion 
of  the  vagus. 

8.  The  lower  dorsal  spinal  nerves  supply  the  pharynx  by 
reason  of  their  connection  with  the  phrenic  and  vagus. 

The  Innervation  of  the  Tonsils. — The  innervation  of  the 
tonsils  is  derived  from  the  following  nerves : 

1.  The  upper  cervical  spinal  nerves,  especially  the  first 
and  second,  influence  the  tonsils  through  their  connection 
with  the  superior  cervical  ganglion  of  the  sympathetic  which 
communicates  with  the  vagus,  the  tonsillar  branch  of  the 
glosso-pharyngeal,  the  pharyngeal  plexus,  Meckel's  ganglion 
which  gives  oiY  the  middle  or  external  palatine  nerve  to  the 
tonsil,  and  the  posterior  palatine  nerve  which  joins  with  the 
middle  palatine  to  form  the  plexus  around  the  tonsil. 

2.  The  fifth,  sixth,  and  seventh  cervical  spinal  nerves  have 
a  decided  influence  upon  the  tonsils,  as  shown  by  clinical 
results  obtained  by  adjustment  of  vertebrae  which  impinge 
these  nerves. 

3.  The  fifth  thoracic  spinal  nerves,  by  their  connection  with 
the  superior  cervical  ganglion  indirectly  influence  the  tonsils. 

The  Innervation  of  the  Larynx. — The  innervation  of  the 
larynx  is  derived  from  the  following  nerves : 

1.  The  first  cervical  spinal  nerve,  through  its  connection 
with  the  vagus  and  its  communication  with  the  superior  cervi- 
cal ganglion  of  the  sympathetic.  The  vagus  in  turn  gives 
off  the  following  branches:     The  superior  laryngeal,  which 


128 


SPINAL  ADJUSTMENT 


Fig.  19. 


Parts  Influenced  by  the  First 
Dorsal  Nerve. 


CRANIUM,  FACE  AND  NECK  129 

is  the  sensory  nerve  of  the  larynx,  and  which  arises  from  the 
inferior  ganglion  of  the  vagus;  it  consists  principally  of  fila- 
ments from  the  spinal  accessory,  and  divides  into  two 
branches,  the  internal  and  external  laryngeal.  The  inferior  or 
recurrent  laryngeal  nerve,  also  a  branch  of  the  vagus,  is  the 
motor  nerve  of  the  larynx,  and  unites  with  the  cardiac  branch 
from  the  vagus  and  the  sympathetic. 

The  sympathetic  laryngeal  nerve  is  one  of  the  internal 
branches  of  the  superior  cer\ical  ganglion,  and  communicates 
with  the  superior  laryngeal  nerve  and  its  branches. 

2.  The  second  pair  of  cervical  spinal  nerves  also  influence 
the  larynx  by  reason  of  their  communication  with  the  superior 
cervical  ganglion  of  the  sympathetic,  and  by  sending  fila- 
ments to  the  terminal  ganglia  by  which  these  structures  are 
innervated. 

3.  The  fourth  pair  of  cervical  nerves  also  communicate 
with  the  terminal  ganglia  of  this  region,  and  with  the  superior 
cervical  ganglion  of  the  sympathetic. 

4.  The  fifth  pair  of  dorsal  spinal  nerves,  through  their 
connection  with  the  superior  cervical  ganglion  have  a  marked 
influence  upon  the  larynx  and  the  throat  as  clinical  results 
frequently  demonstrate. 

The  Innervation  of  the  Tongue. — The  innervation  of  the 
tongue  is  derived  from  the  following  nerves : 

1.  The  hypoglossal  and  glosso-pharnygeal  nerves  are  the 
two  cranial  nerves  which  directly  supply  the  tongue. 

2.  The  first  and  second  cervical  spinal  nerves  influence 
the  tongue  by  reason  of  the  fibres  which  they  send  to  the 
hypoglossal  and  glosso-pharyngeal  nerves.  Also  by  reason 
of  their  communication  with  the  superior  cervical  ganglion 
of  the  sympathetic,  which  in  turn  communicates  wath  the 
hypoglossal  nerve  by  external  branches,  and  with  the  glosso- 
pharyngeal by  a  separate  filament  w^hich  joins  the  petrosal 
ganglion  of  that  nerve. 

3.  The  upper  four  cervical  spinal  nerves  influence  the 
tongue,  by  reason  of  their  connection  with  the  superior  cervi- 
cal ganglion  of  the  sympathetic  which  in  turn  communicates 
with  the  cranial  nerves,  as  follows :  The  lingual  branch  of  the 
fifth,  which  supplies  ordinary  sensibility  to  the  anterior  two- 
thirds  of  the  tongue;  the  chorda  tympani.  in  the   sheath  of 


130 


SPINAL  ADJUSTMENT 


Fig.  20. 


Parts  Influenced  by  the  Second 
Dorsal  Nerve. 


CRANIUM,  FACE  AND  NECK  131 

the  lingual,  which  confers  the  sense  of  taste  on  the  anterior 
two-thirds  of  the  tongue;  the  lingual  branch  of  the  glosso- 
pharyngeal, which  supplies  sensation  and  the  sense  of  taste 
to  the  base  and  sides  of  the  tongue ;  the  superior  laryngeal 
branches  of  the  tenth,  which  distribute  fine  branches  to  the 
root  of  the  tongue  near  the  epiglottis. 

Sympathetic  fibres  pass  to  the  tongue  from  the  nervi 
molles  on  the  lingual  and  other  arteries  supplying  the  tongue. 

4.  The  fifth,  sixth,  and  seventh  cervical  nerves  supply  the 
tongue  through  their  connection  with  the  sympathetic 
branches  to  the  facial  nerve. 

5.  The  fifth  thoracic  spinal  nerve  has  a  marked  effect  upon 
the  tongue,  by  reason  of  its  connection  with  the  superior 
cervical  ganglion.  This  in  turn  communicates  with  the 
terminal   ganglia   of   the  tongue. 

The  Innervation  of  the  Teeth  and  Oral  Cavity. — The  in- 
nervation of  the  teeth  and  oral  cavity  is  derived  from  the 
following  nerves: 

1.  The  upper  four  cervical  nerves,  by  reason  of  their  com- 
munication with  the  superior  cervical  ganglion,  which  unites 
with  the  trifacial  nerve.  The  third  and  fourth  cervical  spinal 
nerves  especially  communicate  with  the  three  divisions  of  the 
fifth  cranial  nerve,  and  adjustment  of  the  vertebrae  causing 
impingement  of  these  nerves  has  a  marked  effect  upon  the 
teeth  and  mouth. 

3.  The  fifth  thoracic  spinal  nerves  afifect  the  teeth  and 
gums,  as  well  as  the  other  structures  of  the  head  and  neck, 
by  reason  of  their  communication  with  the  superior  cervical 
ganglion. 

The  Innervation  of  the  Thyroid  Gland.^ — The  innervation 
of  the  thyroid  gland  is  derived  from  the  following  nerves : 

1.  The  upper  four  cervical  spinal  nerves  influence  the 
thyroid  gland  through  their  connection  with  the  superior 
cervical  ganglion  which  sends  a  branch  of  communication  to 
the  vagus,  branches  of  which  form  the  pharyngeal  plexus 
which  supplies  the  thyroid  gland. 

2.  The  fifth  and  sixth  cervical  nerves  influence  the  thyroid 
gland  by  reason  of  their  communication  with  the  middle 
cervical  ganglion  of  the  sympathetic.  The  thyroid  branches 
of  this  ganglion  directly  supply  the  thyroid  gland;  they  ac- 


132 


SPINAL  ADJUSTMENT 


Fig.  21. 

Parts  Influenced  by  the  Third 
Dorsal  Nerve. 


CRANIUM,  FACE  AND  NECK  133 

company  the  inferior  thyroid  artery  to  the  thyroid  gland. 
They  communicate  on  the  artery  with  the  cardiac  nerves,  and 
in  the  gland  with  the  recurrent  and  external  laryngeal  nerves. 
3.  The  seventh  and  eighth  cervical  nerves  also  influence 
the  thyroid,  since  they  join  the  inferior  cervical  ganglion 
which  sends  fibres  to  the  middle  cervical  ganglion,  and  with 
the  cardiac  and  recurrent  laryngeal  nerves. 


134 


SPINAL  ADJUSTMENT 


Fig.  22. 


Parts  Influenced  by  the  Fourth 
Dorsal  Nerve. 


CHAPTER  II 

The  Innervation  of  the  Organs  of  the  Thorax 

The  Innervation  of  the  Mammary  Gland. — The  innervation 
of  the  mammary  gland  is  derived  from  the  following  nerves : 

1.  The  second,  third,  fourth,  fifth,  and  sixth  dorsal  spinal 
nerves  through  their  anterior  branches,  named  the  upper  or 
pectoral  intercostal  nerves.  These  nerves  give  off  the  lateral 
cutaneous,  the  anterior  branches  of  which  supply  the 
mammary  gland. 

2.  The  upper  thoracic  nerves  further  influence  the 
mammary  gland  through  the  medium  of  the  gray  rami 
communicantes  which  join  the  intercostal  nerves. 

3.  The  lower  cervical  nerves  as  well  as  the  upper  dorsal 
also  influence  the  mammary  gland  through  the  internal  and 
external  intercostal  branches  of  the  brachial  plexus. 

The  Innervation  of  the  Heart. — The  innervation  of  the 
heart  is  derived  from  the  following  nerves : 

1.  The  first,  second,  third  and  fourth  cervical  spinal 
nerves  influence  the  heart  as  a  result  of  their  following  con- 
nections :  They  communicate  with  the  superior  cervical 
ganglion  which  sends  a  branch  to  the  vagus ;  the  branches  of 
the  vagus  which  supply  the  heart  are  the  cervical  cardiac 
branches  which  arise  from  it  at  the  upper  and  lower  part 
of  the  neck;  the  superior  branch  connects  with  the  cardiac 
branches  of  the  sympathetic ;  the  inferior  branch  communi- 
cates with  the  superficial  cardiac  plexus.  The  thoracic  cardiac 
branches  arise  from  the  trunk  of  the  vagus  and  end  in  the 
deep  cardiac  plexus. 

The  superior  cardiac  is  one  of  the  internal  branches  of  the 
superior  cervical  ganglion  of  the  sympathetic;  it  receives  a 
filament  from  the  cord  of  communication  between  the  upper 
and  middle  cervical  ganglia. 

The  deep  cardiac  plexus  is  formed  by  the  cardiac  nerves 
derived  from  the  cervical  ganglia  of  the  sympathetic  and  the 
cardiac  branches  of  the  recurrent  laryngeal  and  vagus. 

135 


136 


SPINAL  ADJUSTMENT 


Fig.  23. 


I'arts  Influenced  by  the  Fifth 
Dorsal  Nerve. 


ORGANS  OF  THE  THORAX  137 

The  superficial  cardiac  plexus  is  formed  by  the  left  supe- 
rior cardiac  nerve,  the  left  (and  occasionally  the  right)  infe- 
rior cervical  cardiac  branches  of  the  vagus,  and  filaments 
from  the  deep  cardiac  plexus.  A  small  ganglion,  the  cardiac 
ganglion  of  Wrisberg,  is  sometimes  found  connected  with 
these  nerves  at  their  point  of  junction.  These  plexuses  supply 
the  surface  and  substance  of  the  heart. 

The  superior  cardiac  nerve,  above  referred  to,  divides 
into  two  branches :  the  right  superior  cardiac  nerve  at  about 
the  middle  of  the  neck  receives  filaments  from  the  external 
laryngeal  nerve;  lower  down,  one  or  two  twigs  from  the 
vagus ;  and  as  it  enters  the  thorax  it  is  joined  by  a  filament 
from  the  recurrent  laryngeal.  Filaments  from  this  nerve 
communicate  with  the  thyroid  branches  from  the  middle 
cervical  ganglion. 

The  left  superior  cardiac  nerve,  in  the  chest,  runs  by  the 
side  of  the  left  common  carotid  artery  and  in  front  of  the 
arch  of  the  aorta  to  the  superficial  cardiac  plexus,  but  occa- 
sionally it  passes  behind  the  aorta  and  ends  in  the  deep 
cardiac  plexus. 

2.  The  fifth  and  sixth  cervical  spinal  nerves  influence 
the  heart  by  their  connection  with  the  middle  cervical  gang- 
lion of  the  sympathetic.  This  ganglion  gives  oflf  the  middle 
cardiac  nerve,  which  divides  into  two  branches.  The  one 
on  the  right  side  receives  a  few  branches  from  the  recurrent 
laryngeal  nerve,  and  joins  the  right  side  of  the  deep  cardiac 
plexus ;  in  the  neck  it  communicates  with  the  superior 
cardiac  and  recurrent  laryngeal  nerves.  On  the  left  side  the 
middle  cardiac  nerve  joins  the  left  side  of  the  deep  cardiac 
plexus. 

3.  The  seventh  and  eighth  cervical  spinal  nerves  influence 
the  heart  by  their  connection  with  the  inferior  cervical  gang- 
lion of  the  sympathetic,  which  gives  oflf  the  inferior  cardiac 
nerve.  This  nerve  communicates  freely  with  the  recurrent 
laryngeal  nerve  and  the  middle  cardiac  nerve. 

4.  The  third,  fourth  and  fifth  cervical  spinal  nerves,  in 
addition  to  the  above  mentioned  connections  with  cardiac 
nerves,  also  give  off  the  phrenic  nerves  which  supply  the 
pericardium,  and  which  assist  in  the  formation  of  the  cardiac 
plexus. 


138 


SPINAL  ADJUSTMENT 


Parts   Influenced   by  the  Sixth 
Dorsal  Nerve. 


ORGANS  OF  THE  THORAX  139 

5.  The  upper  dorsal,  spinal  nerves,  especially  the  second, 
have  a  powerful  influence  upon  the  action  of  the  heart. 

6.  The  fourth  thoracic  spinal  nerves  have  a  vaso-motor 
and  inhibitory  influence  upon  the  heart.  The  action  of  the 
heart  may  be  restored  to  normal  by  removing  pressure  upon 
this  nerve,  as  well  as  by  percussion  over  the  spinous  processes 
of  the  first  and  second  thoracic  vertebrae.  This  influence  of 
the  fourth  thoracic  nerve  upon  the  action  of  the  heart  may  be 
readily  demonstrated  by  using  the  above  described  methods 
when  it  will  be  found  that  the  number  of  heart-beats  may 
be  reduced  from  ninety  per  minute  to  seventy  in  a  few 
minutes. 

7.  The  lower  thoracic  spinal  nerves,  through  their  com- 
munication with  the  terminal  fibres  of  the  phrenic  nerves, 
exert  an  indirect  influence  on  the  heart  action. 

The  Innervation  of  the  Lungs. — The  innervation  of  the 
lungs  is  derived  from  the  following  nerves : 

1.  The  first  cervical  spinal  nerves  influence  the  lungs  by 
sending  a  branch  to  the  vagus,  which  supplies  the  lungs 
through  the  anterior  and  posterior  pulmonary  nerves. 

2.  The  upper  four  cervical  nerves  influence  the  lungs 
through  their  connection  with  the  superior  cervical  ganglion 
of  the  sympathetic,  which  communicates  with  the  vagus. 
The  anterior  pulmonary  branches  of  the  vagus  are  distributed 
to  the  anterior  aspect  of  the  root  of  the  lungs.  They  join 
with  the  filaments  from  the  sympathetic  to  form  the  anterior 
pulmonary  plexus.  The  posterior  pulmonary  branches  are 
distributed  on  the  posterior  aspect  of  the  root  of  the  lungs. 
Branches  from  both  these  plexuses  accompany  the  bronchial 
tubes,  and  have  small  ganglia  along  their  course. 

3.  The  fourth  cervical  spinal  nerves  have  an  especial  in- 
fluence upon  the  lungs.  These  nerves  give  origin  to  the 
phrenic  nerves,  which  have  a  direct  effect  on  the  lungs  by 
reason  of  their  distribution  to  the  pleurae,  pericardium  and 
diaphragm.  As  previously  explained,  these  nerves,  by  gov- 
erning the  movements  of  the  thoracic  viscera,  influence  to  a 
marked  degree  the  cerebral  circulation. 

4.  The  first  to  fourth  thoracic  spinal  nerves  affect  the 
lungs  by  their  connection  with  the  first  four  thoracic  gangha 
of  the  gangliated  cord,  which  communicate  with  the  posterior 


140 


SPINAL  ADJUSTMENT 


Fig.  25. 


I'arts  Influenced  by  the  Seventh 
Dorsal  Nerve. 


ORGANS  OF  THE  THORAX  141 

pulmonary  branch  of  the  vagus  to  form  the  pulmonary  plexus. 
The  third  and  fourth  ganglia  especially,  and  the  first  and 
second  more  rarely  have  this  connection. 

5.  The  third  thoracic  nerves,  however,  have  the  most 
marked  influence  upon  the  lungs.  They  supply  the  entire 
extent  of  the  pleurae  and  the  upper  lobe  of  both  lungs. 

6.  Various  other  spinal  nerves  indirectly  influence  the 
lungs  by  their  connection  with  nerves  influencing  other  or- 
gans, the  proper  function  of  which  has  much  to  do  with  the 
condition  of  the  lungs  or  their  restoration  to  a  normal  state 
when  they  are  diseased. 


142 


SPINAL  ADJUSTMENT 


Fig.  26. 

Parts  Influenced  by  tbe  Eighth 
Dorsal  Nerve. 


CHAPTER  III 

The  Innervation  of  the  Organs  of  the  Abdomen 

The  Innervation  of  the  Peritoneum. — The  innervation  of 
the  peritoneum  is  derived  from  practically  the  same  nerves 
that  supply  the  large  and  small  intestines  (q.  v.).  Its  upper 
portions  are  supplied  by  the  vagus  and  phrenic  nerves,  while 
in  the  lower  portions  of  the  abdomen  it  receives  its  innerva- 
tion from  the  splanchnic  nerves  and  white  rami  from  the 
lower  dorsal  and  upper  lumbar  nerves. 

The  Innervation  of  the  Diaphragm. — The  innervation  of 
the  diaphragm  is  derived  from  the  following  nerves : 

1.  The  first  to  fourth  cervical  spinal  nerves  influence  the 
diaphragm  by  reason  of  their  communication  with  the  vagus 
nerve,  which  assists  in  the  formation  of  the  phrenic  or 
diaphragmatic  plexus,  and  also  sends  fibres  directly  to  the 
diaphragm. 

2.  The  third,  fourth  and  fifth  cervical  nerves  by  entering 
into  the  formation  of  the  phrenic  nerves  have  an  important 
effect  upon  the  diaphragm. 

3.  The  middle  thoracic  nerves  influence  the  diaphragm 
by  their  communication  with  the  fifth  to  tenth  thoracic 
ganglia  of  the  sympathetic,  branches  from  which  form  the 
great  splanchnic  nerves  which  terminate  in  the  semilunar 
plexus,  of  which  the  phrenic  or  diaphragmatic  plexus  is  a 
prolongation. 

4.  The  seventh  to  eleventh  thoracic  nerves  whose  anterior 
divisions,  namely  the  lower  or  abdominal  intercostal  nerves, 
also  supply  the  diaphragm,  have  a  direct  influence  on  this 
structure. 

5.  The  tenth  and  eleventh  thoracic  nerves  further  influence 
the  diaphragm  by  reason  of  their  connection  with  the  corre- 
sponding ganglia  which  give  off  the  lower  splanchnic  nerve 
which  joins  the  solar  plexus,  and,  in  the  chest,  communicates 
with  the  great  splanchnic  nerve. 

143 


144 


SPINAL  ADJUSTMENT 


Fig.  27. 


I'arts  Influenced  by  the  Ninth 
Dorsal  Nerve. 


ORGANS  OF  THE  ABDOMEN  145 

The  Innervation  of  the  Liver. — The  innervation  of  the 
liver  is  very  similar  to  that  of  the  stomach.  The  various 
segments  of  the  spinal  column  affect  the  liver  in  practically 
the  same  manner  that  they  do  the  stomach.  The  innervation 
of  the  liver  is  accordingly  derived  from  the  following  nerves : 

1.  The  upper  cervical  nerves  influence  the  liver  by  their 
connection  with  the  vagus  nerve  which  sends  a  filament  of 
communication  to  the  hepatic  plexus. 

2.  The  third,  fourth  and  fifth  cervical  nerves  also  influ- 
ence the  liver  by  reason  of  their  formation  of  the  phrenic 
nerves  which  send  a  filament  to  the  hepatic  plexus. 

3.  The  middle  thoracic  nerves  influence  the  liver  in  the 
same  manner  and  for  the  same  reason  that  they  influence 
the  stomach.  From  this  region  emanate  the  splanchnic 
nerves,  which  are  derived  from  the  fifth  or  sixth  to  the  ninth 
or  tenth  thoracic  ganglia,  and  which  have  a  direct  influence 
upon  the  liver. 

The  Innervation  of  the  Spleen. — The  innervation  of  the 
spleen  is  derived  from  the  following  nerves : 

1.  The  upper  four  cervical  nerves  influence  the  spleen 
through  their  connection  with  the  vagus  nerve,  in  the  same 
manner  that  these  nerves  influence  the  liver  and  stomach. 

2.  The  third,  fourth  and  fifth  cervical  nerves  also  influence 
the  spleen  by  reason  of  their  entering  into  the  formation  of 
the  phrenic  nerves. 

3.  The  middk  thoracic  spinal  nerves  influence  the  spleen 
through  their  connection  with  the  corresponding  thoracic 
ganglia  of  the  gangliated  cord,  which  latter  communicate  with 
the  splanchnic  nerves  to  the  semilunar  ganglion  of  the  solar 
plexus.  The  left  semilunar  ganglia,  together  with  branches 
from  the  celiac  plexus  and  the  right  vagus  nerve,  form  the 
splenic  plexus,  which  accompanies  the  splenic  artery  to  the 
substance  of  the  spleen. 

The  sixth  dorsal  spinal  nerve  has  the  most  marked 
influence  upon  the  spleen. 

The  Innervation  of  the  Pancreas. — The  innervation  of  the 
pancreas  is  derived  from  the  following  nerves : 

1.  The  upper  four  cervical  spinal  nerves  through  their 
connection  with  the  vagus  nerve  have  an  indirect  influence  on 
the  pancreas. 


146 


SPINAL  ADJUSTMENT 


Fig,  28. 


Parts   Influenced  by  the  Tenth 
Dorsal  Nerve. 


ORGANS  OF  THE  ABDOMEN  147 

2.  The  middle  cervical  nerves,  especially  the  fourth,  by 
forming  the  phrenics  also  influence  the  pancreas. 

3.  The  middle  thoracic  spinal  nerves  through  their  con- 
nection with  the  semilunar  ganglia  and  solar  plexus  have  the 
greatest  effect  on  the  pancreas  and  adrenals.  The  eighth 
dorsal  spinal  nerves  have  the  most  marked  influence  on  the 
pancreas.  Filaments  from  the  splenic  plexus  form  the  pan- 
creatic plexus  and  it  is  the  eighth  thoracic  nerve  which  enters 
most  largely  into  the  formation  of  this  portion  of  the  splenic 
plexus. 

The  Innervation  of  the  Stomach. — The  innervation  of  the 
stomach  is  derived  from  the  following  nerves : 

1.  The  vagus  by  its  terminal  branches  supplies  the  stom- 
ach; the  one  on  the  right  being  distributed  to  the  back  part, 
and  the  left  to  the  front  part  of  the  organ.  Its  communication 
with  spinal  nerves  through  the  rami  communicantes  in  vari- 
ous segments  of  the  spine  makes  possible  the  influence  of  the 
function  of  the  stomach  by  adjustment  of  the  vertebrae  in 
various   regions   of   the  vertebral   column. 

The  splanchnic  nerves  also  influence  the  stomach,  through 
their  termination  in  the  solar  plexus.  Since  these  nerves  com- 
municate with  the  thoracic  ganglia,  and  these  in  turn  with  the 
thoracic  spinal  nerves,  the  stomach  may  be  affected  more 
or  less  directly  and  markedly  by  subluxations  in  this  region 
of  the  spine. 

A  great  number  of  branches  from  the  sympathetic  also  in- 
fluence the  stomach,  and  their  connection  with  the  spinal 
nerves  make  impingement  of  such  spinal  nerves  an  important 
factor  in  the  production  of  various  gastric  disorders. 

2.  The  upper  cervical  spinal  nerves  influence  the  stomach 
and  other  organs  of  the  abdomen  by  their  communication 
with  the  vagus.  Any  impingement  of  these  nerves  will,  there- 
fore, interfere  with  the  action  of  those  parts  supplied  by  the 
vagus. 

3.  The  fourth  cervical  spinal  nerves,  by  forming  in  con- 
nection with  the  third  and  fifth  cervicals  the  phrenic 
nerves,  influence  the  stomach.  The  phrenics  enter  into  the 
formation  of  the  solar  plexus. 

4.  The  fifth,  sixth  and  seventh  pairs  of  thoracic  spinal 
nerves  have  the  most  marked  influence  on  the  stomach.    These 


148 


SPINAL  ADJUSTMENT 


Fig.  29. 


Parts  Influenced  by  the  Eleventh 
Dorsal  Nerve. 


ORGANS  OF  THE  ABDOMEN  149 

nerves   form   the   great   splanchnic   nerves,   which   terminate 
in  the  semilunar  ganglion,  a  portion  of  the  solai  plexus. 

5.  The  tenth  and  eleventh  thoracic  spinal  nerves  have  an 
influence  on  the  stomach.  These  nerves  communicate  with 
the  corresponding  ganglia  of  the  gangliated  cord,  which  in 
turn  form  the  lesser  splanchnic  nerves  which,  together  with 
a  filament  from  the  right  vagus  nerve,  communicate  with  the 
celiac  plexus.  This  plexus  is  a  direct  continuation  of  the 
solar  plexus,  and  gives  off  the  gastric  plexus  which  accom- 
panies the  gastric  artery  along  the  lesser  curvature  of  the 
stomach  and  joins  with  branches  from  the  left  vagus  nerve. 

6.  The  first  and  second  lumbar  nerves,  by  communicat- 
ing with  the  terminal  fibres  of  the  vagus  nerve,  directly  influ- 
ence the  stomach.  It  is  for  this  reason  that  we  find  nausea 
and  vomiting  in  pelvic  disorders  and  especially  in  pregnancy. 

The  Innervation  of  the  Large  Intestine. — The  nerves  that 
supply  the  large  intestine  are  derived  from  the  plexuses  of  the 
sympathetic  nerve  around  the  branches  of  the  superior  and 
inferior  mesenteric  arteries  that  are  distributed  to  the  large 
intestine.  They  are  distributed  in  a  similar  way  to  those  in 
the  small  intestine. 

The  innervation  of  the  large  intestines  is  derived  from  the 
following  nerves : 

1.  The  vagus  nerve  influences  the  large  intestine  by  its 
communication  with  the  celiac  and  splenic  plexuses.  The 
celiac  plexus  is  a  continuation  of  the  solar  plexus,  while  the 
superior  mesenteric  and  aortic  plexuses  which  supply  the 
large  intestines  are  also  derived  from  the  solar  plexus. 

2.  The  lower  thoracic  nerves  influence  the  large  intes- 
tine through  the  splanchnic  nerves,  and  through  the  descend- 
ing fibres  of  white  rami  communicantes.  These  nerves  further 
influence  the  large  intestine  in  the  following  manner:  The 
splanchnic  nerves  terminate  in  the  solar  plexus  and  semilunar 
ganglia  which  give  rise  to  the  aortic  plexus,  from  which  is 
derived  the  inferior  mesenteric  plexus.  This  plexus  surrounds 
the  inferior  mesenteric  artery,  and  subdivides  into  a  number 
of  secondary  plexuses,  which  are  distributed  to  all  the  parts 
supplied  by  the  artery,  namely  the  left  colic  and  sigmoid 
plexuses  which  supply  the  descending  and  sigmoid  flexure  of 
the  colon ;  and  the  superior  hemorrhoidal  plexus,  which  sup- 


150 


SPINAL  ADJUSTMENT 


Fig.  30. 


Parts  Supplied  by  tjie  Twelfth 
Dorsal  Nerve. 


ORGANS  OF  THE  ABDOMEN  151 

plies  the  upper  part  of  the  rectum.  The  ileo-colic,  right 
colic,  and  middle  colic  branches  of  the  superior  mesenteric 
plexus  supply  the  corresponding  parts  of  the  large  intestine. 

3.  The  upper  lumbar  nerves,  especially  the  second,  influ- 
ence the  large  intestines  through  their  connection  with  the 
ganglia  which  communicate  with  the  aortic  plexus. 

4.  The  innervation  of  the  appendix  is  practically  identical 
to  that  of  the  large  intestine,  of  which  it  is  a  part.  Thus 
we  find  that  adjustment  of  the  second  lumbar  vertebra  will 
in  the  great  majority  of  instances  relieve  appendicitis. 

5.  In  addition  to  the  innervation  of  the  upper  part  of  the 
rectum  mentioned  above,  the  lower  portion  is  supplied  by 
the  inferior  hemorrhoidal  plexus  which  arises  from  the  pelvic 
plexus.  This  plexus  communicates  with  the  superior 
hemorrhoidal  plexus. 

The  fourth,  and  especially  the  fifth  lumbar  spinal  nerves 
indirectly  influence  the  rectum  through  their  connection  with 
the  pelvic  plexus  which  supplies  the  rectum. 

The  Innervation  of  the  Small  Intestine. — The  nerves  of  the 
small  intestine  are  derived  from  the  plexuses  of  sympathetic 
nerves  around  the  superior  mesenteric  artery.  From  this 
source  they  run  to  a  plexus  of  nerves  and  ganglia  situated 
between  the  circular  and  longitudinal  muscular  fibres,  named 
Auerbach's  plexus,  from  which  the  nervous  branches  are  dis- 
tributed to  the  muscular  coats  of  the  intestine.  From  this 
plexus  a  secondary  plexus  is  derived,  named  the  plexus  of 
Meissner,  which  is  formed  by  branches  which  have  per- 
forated the  circular  muscular  fibres.  This  plexus  lies  between 
the  muscular  and  mucous  coats  of  the  intestine.  It  is  also 
gangliated,  and  from  it  the  terminal  fibres  pass  to  the 
muscularis  mucosae  and  to  the  mucous  membrane  and  villi. 

The  following  are  the  spinal  segments  which  influence  the 
innervation  of  the  intestine : 

1.  Since  the  vagus  nerve  supplies  the  small  intestines  the 
upper  cervical  spinal  nerves  which  communicate  with  this 
nerve  through  the  medium  of  the  sympathetic  have  an 
influence  on  the  intestines. 

2.  The  phrenic  nerves  also  supply  the  small  intestines,  and 
being  formed  by  the  third,  fourth  and  fifth  cervical  spinal 
nerves,  these  nerves  influence  the  small  intestines. 


152 


SPINAL  ADJUSTMENT 


Fig.  31. 

Parts  Influenced  by  the  First 
Lumbar  Nerve. 


ORGANS  OF  THE  ABDOMEN  153 

3.  The  three  splanchnic  nerves  supply  the  small  intestine, 
and  since  they  communicate  with  the  thoracic  spinal  nerves 
through  the  sympathetic  ganglia  and  rami  communicantes 
these  spinal  nerves  have  a  decided  influence  upon  the  small 
intestine. 

The  great  splanchnic  nerve  is  formed  by  branches  from 
the  thoracic  ganglia  between  the  fifth  and  sixth  and  the  ninth 
or  tenth,  but  the  fibres  in  the  upper  roots  may  be  traced 
upward  in  the  gangliated  cord  as  high  as  the  first  or  second 
thoracic  ganglia.  It  terminates  in  the  semilunar  ganglion  of 
the  solar  plexus. 

The  lesser  splanchnic  nerve  is  formed  by  filaments  from 
the  tenth  and  eleventh  ganglia,  and  from  the  cord  between 
them.  It  joins  the  solar  plexus,  and  communicates  in  the 
chest  with  the  great  splanchnic  nerve. 

The  smallest  splanchnic  nerve  arises  from  the  twelfth 
thoracic  ganglion  and  terminates  in  the  solar  and  renal 
plexuses.  It  sometimes  communicates  with  the  lesser 
splanchnic  nerve. 

4.  The  lumbar  nerves  have  some  influence  upon  the  small 
intestines. 

The  Innervation  of  the  Kidneys. — The  nerves  of  the  kid- 
ney, although  small,  are  about  fifteen  in  number.  They  have 
small  ganglia  developed  upon  them.  They  are  derived  from 
the  renal  plexus,  which  is  formed  by  branches  from  the  solar 
plexus,  the  lower  and  outer  part  of  the  semilunar  ganglion, 
the  aortic  plexus,  and  from  the  lesser  and  smallest  splanchnic 
nerves.  They  communicate  with  the  spermatic  plexus,  and 
this  fact  probably  explains  the  occurrence  of  pain  in  the 
testicle  in  affections  of  the  kidney. 

The  following  are  the  spinal  nerves  which  influence  the 
kidneys : 

1.  The  first  and  second  cervical  spinal  nerves  influence 
the  kidneys  by  reason  of  their  communication  with  the  vagus 
nerve  which  supplies  the  kidneys  indirectly. 

2.  The  lower  thoracic  spinal  nerves  influence  the  kidneys 
by  reason  of  their  connection  with  the  lesser  and  smallest 
splanchnics,  which  communicate  with  the  renal  plexus.  The 
tenth  dorsal  is  the  one  which  has  the  greatest  influence  on 
the  kidney. 


154 


SPINAL  ADJUSTMENT 


Fig.  32. 


Parts  Influenced  by  tlio  Second 
Lumbar   Nerve. 


ORGANS  OF  THE  ABDOMEN  155 

The  Innervation  of  the  Suprarenal  Capsule. — The  ninth 
thoracic  nerves  have  the  greatest  influence  on  the  suprarenal 
capsule.  The  suprarenal  plexus,  which  supplies  the  adrenal 
bodies  is  formed  by  branches  from  the  solar  plexus,  the  outer 
part  of  the  semilunar  ganglion,  and  from  the  phrenic  and 
great  splanchnic  nerves,  a  ganglion  being  formed  at  the  point 
of  junction  of  the  latter  nerve.  The  branches  of  this  plexus 
are  remarkable  for  their  large  size  in  comparison  with  the 
size  of  the  organ  which  they  supply. 


156 


SPINAL  ADJUSTMENT 


Fig.  33.  • 

rarts  Influenced  by  the  Third 
Lumbar  Nerve. 


CHAPTER  IV 

The  Innervation  of  the  Organs  of  the  Pelvis 

The  Innervation  of  the  Bladder. — The  nerves  of  the  blad- 
der are  derived  from  the  pelvic  plexus  of  the  sympathetic  and 
from  the  second,  third  and  fourth  sacral  nerves;  the  former 
supply  the  upper  part  of  the  organ,  while  the  latter  supply 
its  base  and  neck.  The  sympathetic  fibres  have  ganglia  con- 
nected with  them,  which  send  branches  to  the  vessels  and 
muscular  coat.  The  pelvic  plexus  is  formed  by  a  continua- 
tion of  the  hypogastric  plexus,  by  branches  from  the  second, 
third,  and  fourth  sacral  nerves,  and  by  a  few  filaments  from 
the  first  two  sacral  ganglia.  From  this  plexus  numerous 
branches,  which  accompany  the  branches  of  the  internal  iliac 
artery,  are  distributed  to  all  the  viscera  of  the  pelvis. 

The  specific  plexus  which  supplies  the  bladder  is  the 
vesical  plexus,  which  arises  from  the  fore  part  of  the  pelvic 
plexus.  The  nerves  composing  it  are  numerous,  and  contain 
a  large  proportion  of  spinal  nerve-fibres.  They  accompany 
the  vesical  arteries,  and  are  distributed  at  the  side  and  base 
of  the  bladder.  Numerous  filaments  also  pass  to  the  seminal 
vesicles  and  vas  deferens ;  those  supplying  the  vas  deferens 
unite  with  branches  of  the  spermatic  plexus  on  the  spermatic 
cord. 

The  spinal  nerves  which  have  the  greatest  influence  on  the 
bladder  are  the  eleventh  thoracic  and  the  first  lumbar.  These 
nerves  communicate  with  the  vesical  plexus  by  connecting 
with  the  corresponding  ganglia  of  the  sympathetic,  which  send 
internal  branches  that  communicate  with  the  hypogastric 
plexus. 

The  most  marked  efifect  upon  the  bladder  is  obtained  by 
adjustment  of  the  first  and  fifth  lumbar  vertebrae. 

The  Innervation  of  the  Uterus. — The  nerves  to  the  uterus 
are  derived  from  the  inferior  hypogastric  and  ovarian  plexuses, 
and  from  the  third  and  fourth  sacral  nerves.  The  uterine 
plexus  which  specifically  supplies  the  uterus  arises  from  the 

157 


158 


SPINAL  ADJUSTMENT 


Parts  Influenced  by  the  Fourth 
Lumbar  Nerve. 


ORGANS  OF  THE  PELVIS  159 

upper  part  of  the  pelvic  plexus  above  the  point  where  the 
branches  from  the  sacral  nerves  unite  with  that  plexus.  Its 
branches  accompany  the  uterine  arteries  to  the  side  of  the 
organ  between  the  folds  of  the  broad  ligament,  and  are  dis- 
tributed to  the  substance  of  the  lower  part  of  the  body  of 
the  uterus  and  to  the  cervix.  Branches  from  the  uterine 
plexus  also  accompany  the  uterine  arteries  into  the  substance 
of  the  organ,  and  have  numerous  ganglia  developed  upon 
them.  Other  filaments  pass  separately  to  the  fundus  and  the 
Fallopian  tubes. 

The  following  spinal  nerves  influence  the  uterus : 

1.  The  lower  thoracic  nerves,  through  their  communica- 
tion with  the  pelvic  plexus  have  an  influence  on  the  uterus. 

2.  The  lumbar  nerves  also  influence  the  uterus  by  reason 
of  their  communication  directly  with  the  hypogastric  and 
uterine  plexuses.  The  fourth  lumbar  especially  controls  the 
uterus,  and  adjustment  of  this  vertebra  is  indicated  in  various 
uterine  disorders. 

The  Innervation  of  the  Prostate  Gland. — The  nerves  which 
supply  the  prostate  gland  are  derived  from  the  pelvic  plexus, 
through  the  medium  of  the  prostatic  plexus.  The  nerves  com- 
posing this  plexus  are  of  large  size.  They  are  distributed  to 
the  prostate  gland,  seminal  vesicles,  and  erectile  tissue  of  the 
penis. 

The  spinal  nerves  which  have  an  influence  on  the  prostate 
gland  are  the  following: 

1.  The  lower  thoracic  spinal  nerves,  by  their  connection 
with  the  pelvic  plexus  have  some  influence  upon  the  prostate 
gland. 

2.  The  lumbar  nerves,  however,  have  the  most  marked  in- 
fluence upon  this  organ,  and  the  nerves  which  most  directly 
influence  it  are  the  first  and  fifth  lumbar. 

The  Innervation  of  the  Ovaries. — The  nerves  which  sup- 
ply the  ovary  are  derived  from  the  pelvic  plexus  and  from 
the  ovarian  plexus.  The  pelvic  plexus  has  been  previously 
described.  The  ovarian  plexus  is  derived  from  the  renal 
plexus,  and  is  distributed  to  the  ovaries  and  the  fundus  of  the 
uterus. 

The  spinal  nerves  that  influence  the  ovaries  are  the 
following : 


160 


SPINAL  ADJUSTMENT 


Fig.  35. 


Parts  Influenced  by  the  Fifth 
Lumbar  Nerve. 


ORGANS  OF  THE  PELVIS  161 

1.  The  tenth,  eleventh,  and  twelfth  thoracic  nerves  form 
the  lesser  and  smallest  splanchnics,  which  assist  in  the  forma- 
tion of  the  renal  plexus  from  which  the  ovarian  plexus  is 
derived. 

2.  The  lumbar  nerves,  by  their  connection  with  the  lum- 
bar ganglia  which  assist  in  the  formation  of  the  hypogastric 
plexus  from  which  the  pelvic  and  finally  the  ovarian  plexus 
are  derived,  also  influence  the  ovaries.  The  third  lumbar 
nerve,  especially,  influences  the  ovaries. 

The  Innervation  of  the  Testicles. — The  nerve-supply  of 
the  testicles  is  analogous  to  that  of  the  ovaries.  It  is  de- 
rived from  the  spermatic  plexus  which,  like  the  ovarian  plexus, 
is  a  branch  of  the  renal  plexus.  It  accompanies  the  spermatic 
vessels  to  the  testes. 

The  spinal  nerves  which  influence  the  testes  are  the  same 
as  those  which  influence  the  ovary. 

The  Innervation  of  the  Vagina. — The  nerve-supply  of  the 
vagina  is  derived  from  the  vaginal  plexus,  which  arises  from 
the  lower  part  of  the  pelvic  plexus.  It  is  lost  on  the  walls  of 
the  vagina,  being  distributed  to  the  erectile  tissue  on  its  ante- 
rior part  and  to  the  mucous  membrane.  The  nerves  compris- 
ing this  plexus  contain,  like  those  of  the  vesical,  a  large 
number  of  spinal  nerve-fibres. 

The  spinal  nerves  which  influence  the  vagina  are  identical 
with  those  which  afifect  the  uterus. 

The  Innervation  of  the  Penis. — The  nerves  which  supply 
the  penis  are  comprised  of  two  sets,  namely,  the  large  and 
small  cavernous  nerves.  These  are  slender  filaments  which 
arise  from  the  front  part  of  the  prostatic  plexus,  and,  after 
uniting  with  branches  from  the  internal  pudic  nerve,  pass 
forward  beneath  the  pubis. 

The  second  and  fourth  lumbar  nerves  are  the  spinal  nerves 
which  have  the  most  decided  influence  upon  this  organ,  by 
reason  of  their  connection  with  the  hypogastric  plexus  through 
the  corresponding  lumbar  ganglia. 


SECTION  FOUR 
Vertebral  Mal-Alignment 


CHAPTER  I 
The  Etiology  of  Abnormal  Nerve  Function 

We  have  seen  in  the  previous  section  that  the  nervous 
system  penetrates  every  part  and  parcel  of  the  body.  So 
much  so,  that  were  all  the  other  portions  of  the  body  removed 
and  the  nervous  system  left  intact,  the  human  figure  could 
still  be  recognized.    Fig.  36. 

It  was  also  shown  how  every  part  of  the  body  is  dependent 
upon  the  nervous  system  for  its  organic  integrity  and  its 
functional  activity. 

As  a  result,  were  the  human  organism  deprived  of  this 
dynamic  influence,  the  harmony  normally  existing  between 
its  component  parts  would  be  destroyed,  and  functional  and 
organic  disorders  would  rapidly  supervene. 

Even  though  the  brain  itself,  which  is  the  producing  and 
receiving  centre  of  all  impulses,  be  organically  and  function- 
ally perfect,  it  would  be  useless,  were  the  irritability  and 
conductivity  of  the  nerves  impaired.  This  is  true  because 
the  brain  is  as  dependent  on  the  nerves  for  transmitting  im- 
pulses to  and  from  it  as  are  the  nerves  on  the  brain  for  the 
receiving  of  impulses. 

So  long,  therefore,  as  the  nerve  irritability  and  conduc* 
tivity  are  intact,  there  will  be  a  normal  flow  of  impulses  and 
a  condition  of  health.  When,  however,  the  nerves  are  pre- 
vented from  conducting  a  continuous  flow  of  impulses,  the 
vital  processes  are  impaired,  and  the  body  then  becomes  sus- 
ceptible to  the  secondary  and  contributing  factors  in  the 
production  of  disease.  An  acute  disease  may  follow.  If  the 
interference  with  the  nerve  impulses  persists,  it  becomes  the 
cause  of  the  continuance  of  a  chronic  disorder. 

163 


164 


SPINAL  ADJUSTMENT 


Fig.  36. 

Phantom  of  Nervous  System. 


ABNORMAL  NERVE  FUNCTION  165 

The  Causes  of  Disturbed  Nerve  Function. — A  thorough 
knowledge  of  the  various  w^ays  in  which  disturbed  nerve 
function  may  be  produced  is  naturally  very  important,  for 
upon  the  principal  cause  of  this  disturbed  function,  namely 
vertebral  subluxations,  depends  the  science  of  spinal  adjust- 
ment. A  detailed  discussion  of  the  causes  of  disturbed  nerve 
function  other  than  vertebral  lesions  is  scarcely  necessary  in 
a  work  of  this  nature,  and  they  will  be  referred  to  only  briefly. 

The  causes  of  disturbed  nerve  function  embrace  those 
factors  which  operate  to  alter  the  strength  of  the  conduction 
process,  for  upon  its  conductivity  depends  its  functional 
activity,  namely  the  conveying  of  impulses  to  and  from  the 
central  nervous  system.  These  causes  may,  accordingly  be 
classed  as  follows : 

(a)  Fatigue. 

(b)  Malnutrition. 

(c)  Traumatism. 

(d)  Extremes  of  Temperature. 

(e)  Chemicals  and  Drugs. 

(f)  Mechanical  Conditions. 

Fatigue  of  Nerves.^ — Almost  every  form  of  protoplasm, 
when  stimulated  to  prolonged  action,  deteriorates  and  finally 
fails  to  act.  Such  cannot  be  said  of  nerve-fibres,  however, 
for  they  have  been  experimentally  excited  numerous  times 
per  second,  for  many  hours,  and  still,  at  the  end  of  that  time, 
were  capable  of  developing  an  impulse  at  the  stimulated  point. 
Why  this  is  so  is  still  not  known.  If,  as  is  generally  sup- 
posed, the  nerve-impulse  is  a  form  of  energy  which  passes 
along  the  length  of  the  nerve,  and  since  the  liberation  of 
energy  implies  the  breaking  down  of  chemical  combinations, 
it  seems  strange  on  a  superficial  view  that  fatigue  apparently 
does  not  result.  The  nerve-cells,  however,  appear  to  tire 
after  frequent  excitation.  This  fact  appears  to  make  the  lack 
of  fatigue  of  the  nerve-fibres  still  more  perplexing,  since  the 
latter  are  direct  processes  of  the  nerve-cell. 

Fatigue  of  nerves  must  therefore  be  looked  upon  as  fatigue 
not  of  the  conduction  apparatus,  but  of  the  centre  which  gen- 
erates the  impulse.  That  the  conduction  of  nerve-impulses 
does  not  exhaust  the  nerve-fibre  shows  that  the  process  of 


166  SPINAL  ADJUSTMENT 

conduction  does  not  involve  any  change  in  the  substance  of 
the  nerve-fibre.  Generation  of  the  impulses  does  involve 
chemical  changes  in  the  nerve-centre,  and  therefore  the  nerve- 
cell  may  become  exhausted ;  conduction  of  the  impulse  does 
not  involve  any  chemical  change,  and  hence  the  nerve-fibre 
does  not  become  fatigued  by  conducting  the  impulses,  no  mat- 
ter how  often  repeated. 

Consequently,  when  the  nerve-fibre  is  experimentally  ex- 
cited, it  does  not  become  fatigued  because  it  has  generated 
nothing,  at  the  expense  of  its  own  structure,  the  impulse  which 
it  conveyed  having  been  generated  by  the  electric  apparatus 
which  excited  the  nerve  to  action,  and  acted  in  the  same  ca- 
pacity that  the  nerve-cell  does  in  the  living  body. 

Fatigue  of  a  nerve-centre  is  well  illustrated  by  the  in- 
ability to  detect  the  odor  of  a  perfume  of  a  certain  kind,  after 
having  previously  smelled  various  other  kinds.  The  repeated 
stimulation  of  the  olfactory  centre  tires  it  until  finally  it  no 
longer  correctly  interprets  the  impulse  received  and  is  unable 
to  send  an  impulse  to  the  olfactory  portion  of  the  Schneiderian 
membrane  of  the  nose  to  which  the  sense  of  smell  is  referred. 

Malnutrition  of  Nerves. — The  nerve-fibre,  in  order  to  pre- 
serve its  irritability,  must  receive  a  constant  supply  of  blood. 
Even  though  the  nerve-fibre  depends  for  its  nourishment  upon 
the  cell-body  from  which  it  is  derived,  it  must  be  plentifully 
supplied  with  blood  and  also  oxygen.  For  example,  it  is  seen, 
experimentally,  that  a  nerve  retains  its  irritability  much 
longer  in  oxygen  than  in  air,  and  longer  in  air  which  con- 
tains oxygen  than  that  which  does  not. 

Malnutrition,  therefore,  is  always  productive  of  disturbed 
nerve  function.  When,  for  example,  the  abdominal  aorta  of 
a  rabbit  was  ligated,  complete  paralysis  of  the  lower  limbs, 
both  motor  and  sensory,  followed  very  soon.  This  paralysis 
was  due,  in  the  first  place,  to  loss  of  function  of  the  nerve- 
cells  in  the  spinal  cord,  and  later  to  loss  of  irritability  of  the 
nerves  of  the  limbs. 

This  shows  that  nerves  deprived  of  their  nourishment  lose 
their  function.  Such  deprivation  of  the  nerves  of  blood  and 
oxygen  occurs  in  the  living  body  when  an  improper  quality 
or  a  deficient  quantity  of  food  is  ingested.  It  is  also  a  result 
of  faulty  digestion  and  assimilation. 


ABNORMAL  NERVE  FUNCTION  167 

The  nerve-cells  in  the  spinal  cord  derive  their  blood-supply 
from  the  vessels  in  the  sheath  of  the  spinal  nerve.  If  a  dis- 
placement of  a  vertebra,  sufficiently  marked  to  produce  pres- 
sure upon  these  vessels  by  the  margins  of  the  intervertebral 
foramen,  occurs,  the  nourishment  of  the  corresponding  seg- 
ment of  the  cord  suffers.  As  a. result  of  this  the  nerve-cells 
in  that  segment  are  affected,  and  we  find  disturbed  function 
in  those  parts  of  the  body  supplied  by  the  nerve-cells  which 
are  involved. 

Traumatism  of  Nerves. — The  point  at  which  a  nerve  is 
most  liable  to  injury  is  at  the  intervertebral  foramina.  The 
place  of  injury  to  a  nerve  where  the  greatest  measure  of  ill 
effects  ensue  is  also  at  the  intervertebral  foramina.  They  are 
most  liable  to  injury  at  this  point  because  in  this  location 
along  their  course  they  pass  between  movable  bones  which 
are  subject  to  more  or  less  marked  displacement. 

The  nerves  naturally  may  be  injured  at  any  point  along 
their  course,  but  such  an  injury  is  usually  local  in  its  effects, 
and  regeneration  soon  occurs,  with  reestablishment  of  the 
function  of  those  parts  supplied  by  it.  But  when  the  injury 
is  produced  by  a  subluxated  vertebra,  it  persists  until 
mechanically  corrected.  Since  the  primary  divisions  of  the 
nerves  in  such  cases  are  affected,  the  effects  are  marked  in 
their  distribution  and  severity. 

That  pressure  upon  a  nerve  disturbs  its  power  of  con- 
ductivity every  one  has  had  occasion  to  demonstrate  on  him- 
self. For  example,  if  pressure  is  brought  to  bear  upon  the 
ulnar  nerve  where  it  crosses  the  elbow,  the  region  supplied  by 
the  nerve  becomes  numb. 

The  most  common  ways  in  which  nerves  are  injured  are 
by  tearing,  blows,  cuts,  pinching,  twitching,  stretching,  and 
pressure. 

The  most  important  of  these  is  pressure  at  the  interver- 
tebral foramina,  for  the  reason  that  the  producing  cause  re- 
mains in  operation  until  the  vertebral  displacement  is  cor- 
rected by  "adjustment"  of  the  vertebra.  The  effects  of  such 
pressure  vary  from  those  of  slight,  to  those  of  the  greatest 
seriousness. 

The  Effect  of  Extremes  of  Temperature  on  Nerves. — 
Changes    in    temperature,    if    sudden    and    extreme,    irritate 


168  SPINAL  ADJUSTMENT 

nerves.  If,  for  example,  the  elbow  be  dipped  into  ice-water, 
the  ulnar  nerve  is  excited,  and  in  addition  to  the  sensations 
from  the  skin,  the  subject  feels  pain  in  all  parts  supplied  by 
the  nerve.  As  the  effect  of  the  cold  becomes  more  marked,  the 
pain  is  replaced  by  numbness,  which  shows  that  both  the 
irritability  and  the  power  of  conduction  of  the  nerve  have 
been  reduced.  As  to  increased  temperature,  it  may  be  said 
that,  raising  the  temperature  above  the  usual  temperature 
of  the  body  increases,  while  cooling  decreases  the  irritability 
of  the  nerves. 

The  same  applies  to  the  conductivity  of  the  nerves.  Thus, 
both  the  sympathetic  and  the  vagus  nerve-fibres  have  their 
influence  on  the  heart-beat  increased  by  heat,  and  decreased 
by  cold,  in  experiments  on  a  frog. 

It  has  been  observed  that  if  cold  be  applied  locally  to  a 
nerve,  the  part  afifected  cannot  conduct  an  impulse,  and  acts 
as  a  block  to  the  passage  of  any  impulses  along  that  nerve. 
On  the  other  hand,  the  impulse  is  increased  in  strength 
if  it  passes  through  a  part  which  has  been  previously 
warmed. 

The  proper  temperature  of  the  body  is  maintained  and 
equalized  by  the  blood.  In  this  way,  in  addition  to  other 
acts  which  it  performs,  it  exerts  a  marked  influence  upon  the 
irritability  of  the  nerves,  and  their  conductivity.  Thus,  when 
the  artery  passing  through  an  intervertebral  foramen  in  the 
sheath  of  the  spinal  nerve  is  compressed  as  a  result  of  a  sub- 
luxation of  a  vertebra,  the  heat  which  it  conveys  to  the  parts 
through  the  medium  of  the  blood  is  withdrawn.  This  diminu- 
tion of  the  amount  of  heat,  in  addition  to  the  defective  nutri- 
tion which  also  results,  causes  the  power  of  conductivity  of 
the  nerve  to  become  enfeebled. 

The  Effect  of  Chemicals  and  Drugs  on  Nerves. — The  ir- 
ritability of  ner\^es  is  greatly  influenced  by  even  slight  changes 
in  the  constitution  of  their  protoplasm.  Thus,  if  a  nerve  be 
allowed  to  lie  in  a  liquid  of  a  different  nature  than  its  own 
normal  fluid  medium,  and  especially  if  such  a  liquid  enters  the 
blood  vessels  which  supply  the  nerve,  its  irritability  is  soon 
destroyed. 

For  this  reason  a  certain  chemical  constitution  of  the 
nerve  protoplasm  must  be  maintained,  because  even   slight 


ABNORMAL  NERVE  FUNCTION  169 

variations  from  this  will  alter  or  destroy  the  irritability  of 
the  nerve. 

The  first  result  of  chemicals  is  to  increase  the  irritability 
of  the  nerves,  but  this  effect  is  only  transient,  and,  as  stated 
above,  is  soon  followed  by  a  diminished  irritability.  Various 
drugs  used  to  stimulate  nerve-action  accomplish  the  desired 
result,  but  the  eiTects  are  not  lasting,  and  finally  are  wanting 
altogether.  For  example,  different  drugs  are  given  in  con- 
stipation to  promote  evacuation  of  the  bowels.  At  first  these 
drugs  sufficiently  arouse  the  irritability  of  the  nerves  con- 
trolling the  bowels  to  produce  the  efifect  desired  namely, 
evacuation  of  their  contents.  Finally,  however,  one  after 
another,  these  drugs  fail  to  act,  the  irritability  of  the  nerves 
having  been  so  diminished  that  impulses  are  no  longer  gen- 
erated and  conveyed  to  the  parts  supplied.  It  is  for  this  rea- 
son that  drugs  are  so  uniformly  useless  in  the  treatment  of 
chronic  constipation. 

Other  drugs  are  used  for  their  depressing  efifect,  namely 
to  retard  nerve  function.  This  is  also  accomplished  by  rapidly 
diminishing  the  irritability  of  the  nerves,  and  by  directly  be- 
numbing the  nerve-centres,  or  by  overstimulating  the  nerves 
until  a  state  of  exhaustion  rapidly  supervenes. 

The  Effect  of  Mechanical  Conditions  on  Nerves. — This,  the 
most  common  of  all  the  causes  of  disturbed  nerve  function, 
has  had  less  attention  than  any  of  the  other  causes  enumerated. 

A  sudden  blow,  pinch,  twist,  or  cut  excites  a  nerve.  We 
have  all  experienced  this  efifect  on  a  sensory  nerve,  by  acci- 
dental blows  on  the  ulnar  nerve  at  the  point  where  it  passes 
over  the  elbow,  "the  funny  bone." 

Mechanical  applications  to  nerves  first  increase  and  later 
lessen  and  destroy  their  irritability.  Thus  pressure,  gradu- 
ally applied,  first  increases  and  later  diminishes  the  power  to 
respond  to  irritants. 

The  most  common  form  of  continuous  pressure  upon  a 
nerve  is  that  produced  by  the  margins  of  the  intervertebral 
foramen  when  a  vertebra  is  subluxated.  A  slight  amount  of 
pressure  of  this  kind  upon  a  ner\-e  will  increase  its  irritability. 
Its  action  will  then  be  increased.  Continuous  pressure  of  a 
more  marked  degree  will  finally  destroy  all  sensibility  of  the 
nerve,  and  cause  its  action  to  be  abolished. 


170  SPINAL  ADJUSTMENT 

The  power  of  conductivity  of  nerves  is  similarly  aflfected 
by  pressure  upon  them.  The  efifect  of  pressure  to  lessen  the 
conductivity  of  nerves  is  one  which  every  one  has  had  occa- 
sion to  demonstrate  on  himself.  For  example,  if  pressure  be 
brought  to  bear  on  the  ulnar  nerve  where  it  crosses  the  elbow, 
the  region  supplied  by  the  nerve  becomes  numb. 

The  great  majority  of  all  the  functions  of  the  various 
systems  of  the  body  are  produced  as  a  result  of  the  mechanical 
stimulation  of  the  afferent  nerves  from  such  organs.  Thus  the 
presence  of  food  in  the  mouth  reflexly  excites  the  secretory 
activity  of  the  salivary  glands.  This  is  accomplished  by  the 
sending  of  an  afferent  impulse  from  the  nerve-endings  in 
the  mouth,  which  reflexly  produces  a  stimulus  through  the 
efferent  nerves  to  the  salivary  glands,  with  the  result  that 
saliva  is  produced. 

From  the  foregoing  it  is  apparent  that  although  there  are 
other  causes  than  vertebral  subluxations  which  operate  to 
produce  abnormal  nerve  function,  still  such  displacements  are 
really  the  underlying  cause  in  most  cases.  Whether  the  cause 
ascribed  be  malnutrition,  or  some  other  cause,  such  a  cause 
is  usually  secondary  to  a  pre-existing  vertebral  displacement, 
and  these,  therefore,  become  the  most  important  single  factor 
in  the  production  of  disturbed  nerve  function. 


CHAPTER  II 

Vertebral  Mal-Alignment 

The  human  body  is  generally  regarded  as  a  most  wonder- 
ful and  intricate  piece  of  mechanism.  The  central  pivot,  upon 
which  hangs  every  unit  of  this  mechanism,  is  the  vertebral 
column.  The  spine  thus  becomes  the  most  important  part  of 
the  body. 

It  is  strange,  therefore,  that  so  very  little  time  has  been 
devoted  to  the  study  of  this  part  of  the  body.  Every  other 
portion  has  received  careful  consideration  by  the  students  of 
anatomy,  but  the  spine  has  received  very  slight  attention.  So 
also,  clinicians  have  investigated  everything  having  the  slight- 
est bearing  on  the  production  of  disease,  but  the  possibility 
of  minor  lesions  in  the  spine  as  a  factor  in  producing  disease 
has  been  entirely  overlooked. 

If,  as  previously  pointed  out,  proper  function  and  organic 
integrity  of  every  part  of  the  body  depend  upon  normal  nerve 
function,  then  the  vertebral  column  is  the  most  important 
part  of  the  body,  from  a  clinical  viewpoint.  This  is  true  for 
the  reason  that  the  location  at  which  interference  with  nerve 
function  is  most  likely  to  occur  is  at  the  point  where  soft 
nerves  pass  between  hard,  movable  bones,  namely  through  the 
intervertebral  foramina,  and  where  they  are  constantly  in 
danger  of  being  impinged  upon.  This  impingement,  as  we 
have  already  seen,  will  so  impair  the  conductivity  of  the 
nerves  as  to  check  the  flow  of  impulses  to  the  parts  for  which 
they  are  destined. 

It  is  true  that  major  lesions  of  the  spine  have  received 
proper  attention.  But  the  possibility  of  the  existence  of 
minor  injuries  has  never  been  investigated  until  the  clinical 
results  obtained  through  spinal  adjustment  made  it  plain  that 
vertebral  lesions  of  a  minor  character  are  the  greatest  single 
factor  in  the  production  of  disease. 

Probably  another  reason  why  vertebral  subluxations  have 
received  so  little  credit  in  the  etiology  of  disease  is  that,  while 

171 


172 


SPINAL  ADJUSTMENT 


Fig.  37. 

TiiK  Normal  Spine. 

This    illustrates    the    normal    spine.      Compare   it   with    figure    40,    which    shows 

certain   vertebrae   subluxated,   as  described   under  that   figure. 


VERTEBRAL  MAL-ALIGNMENT  173 

the  body  has  always  been  regarded  as  a  piece  of  mechanism, 
its  mechanical  possibilities  have  never  been  studied. 

The  Nature  of  Subluxations. — An  exact  knowledge  of  pre- 
cisely what  is  meant  when  the  term  "subluxation"  is  used,  has 
been  the  chief  cause  of  the  failure  of  many  to  investigate 
spinal  adjustment. 

The  general  opinion  has  been  that  by  the  term  subluxation 
a  dislocation  is  understood  to  be  implied.  Such  is,  however, 
the  wrong  construction  of  the  term,  and  a  complete  disloca- 
tion in  the  general  acceptance  of  that  word,  is  not  what  the 
term  implies.  A  dislocation  of  a  vertebra  without  fracture 
is  practically  impossible.  A  subluxation  is  not  a  disarticula- 
tion of  a  vertebra  from  the  adjacent  vertebrae  above  and  be- 
low it.  It  is  simply  a  slight  change  in  the  relative  position  of 
a  vertebra  with  the  contiguous  surfaces  of  the  vertebrae  above 
and  below  it.  That  is  to  say,  instead  of  the  entire  surface 
area  of  a  vertebra  being  approximated,  with  die-like  precision, 
to  its  fellows  above  and  below  it,  it  is  slightly  moved  from 
this  position.  There  is  not  an  absolute  and  entire  separation 
of  the  articular  processes  of  two  vertebrae ;  the  greater  part 
of  their  surface  area  still  oppose  each  other ;  there  has  simply 
been  a  shifting  of  the  position  of  one  upon  the  other.  This 
movement  is  in  various  directions  depending  on  the  configura- 
tion of  the  articular  processes  and  the  manner  of  application 
of  the  forces  which  produce  the  displacement.  These  various 
forms  of  subluxations  will  be  considered  in  detail  in  a  future 
chapter. 

When  displacement  of  a  vertebra  occurs,  the  lumen  of 
the  intervertebral  foramen  must  of  necessity  be  encroached 
upon  by  the  displaced  portions,  and  its  opening  narrowed. 
This  fact  rests  upon  the  physical  axiom  that,  any  movement 
toward  the  centre  of  an  opening  of  the  parts  bounding  it, 
diminishes  its  area.  Further,  whatever  is  contained  in  a 
space  so  diminished  in  area  is  either  compressed  or  displaced. 
If  it  is  softer  than  the  parts  pressing  upon  it,  compression  will 
occur.  This  is  what  occurs  in  vertebral  subluxations,  where 
hard  bone  presses  on  soft  nerves,  blood-vessels,  and  lym- 
phatics. 

This,  then,  is  what  is  meant  by  vertebral  subluxation, 
namely,  a  displacement  of  a  vertebra,  resulting  in  an  impinge- 


174 


SPINAL  ADJUSTMENT 


Fig.  38. 

Anterior  Aspect  of  Spine. 

(A  and  B)  Compression  of  the  right  side  of  the  discs  between  the  first,  sec- 
ond, and  third  dorsal  vertebrae  with  approximation  of  these  vertebrae  on  that 
side  and  narrowing  of  the  intervertebral  dorsal  foramina. 

(C)    Lateral  displacement  of  the  fifth  dorsal  vertebra  to   the  left. 

(D,  E,  and  F)  Compression  of  the  anterior  portion  of  the  discs  between  the 
ninth,  tenth,  eleventh,  and  twelfth  dorsal  vertebrae. 

(G)    Rotary   displacement  of   the  second   lumbar  vertebra  to   the  right   side. 

(II)  Compression  of  the  right  side  of  the  disc  between  the  fourth  and  fifth 
liunbnr  vertebrae. 


VERTEBRAL  MAL-ALIGNMENT  175 

nient  of  the  structures  in  the  intervertebral  foramen  by  the 
displaced  mari^ins  of  the  foramen. 

General  Results  of  Mal-Alignment  of  the  Vertebrae. — 
Minor  vertebral  lesions,  as  has  been  repeatedly  mentioned, 
produce  certain  diseases.  It  is  not  intended  to  convey  the  im- 
pression that  all  diseases  are  due  to  lesions  of  the  spine.  There 
are  some  disorders  which  are  so  evidently  the  result  of  other 
factors,  that  it  would  be  irrational  to  presume  that  a  vertebral 
subluxation  was  responsible  for  the  abnormality  in  question. 
But  it  is  a  fact  which  cannot  be  successfully  denied  that  not 
one  other  single  thing  is  productive  of  so  many  abnormal 
conditions  as  are  subluxations  of  the  vertebrae.  This  state- 
ment is  not  only  vouched  for  by  a  thorough  study  of  the 
"mechanics"  of  the  vertebral  column,  but  is  also  proven  by 
the  clinical  results  achieved  by  adjustment  of  the  vertebrae 
wherever  subluxations  are  the  basis  of  abnormal  conditions. 

Spontaneous  Adjustment.- — A  great  majority  of  the  sub- 
luxations which  are  sustained  during  the  day  are  corrected 
during  sleep.  Nature,  in  every  case,  makes  an  effort  to  correct 
spontaneously  all  the  slight  displacements  of  the  vertebrae  in- 
curred during  the  previous  day.  When  we  are  relaxed  in 
sleep,  those  vertebral  subluxations  which  are  not  too  severe 
are  adjusted  in  this  way.  When,  however,  a  vertebra  is  so 
far  out  of  alignment  that  the  equalizing  of  muscular  and 
ligamentous  laxity  and  rigidity  on  both  sides  will  not  permit 
it  to  spontaneously  resume  its  proper  position,  then  mechanical 
means  are  required. 

Sleep  is  the  great  restorative  of  vital  energy  because  it 
produces  a  state  wherein  the  generation  of  nerve-impulses  is 
temporarily  diminished  or  suspended.  It  is  because  the  con- 
tinuous flow  of  impulses  ceases  during  this  time,  that  the 
state  of  constant  contraction  of  the  muscles  is  absent,  and 
relaxation  of  muscles  and  ligaments  takes  place.  In  like  man- 
ner, most  organs,  during  deep  sleep,  cease  to  function  be- 
cause the  nerve  impulses  necessary  to  their  functional  activity 
are  not  being  generated.  Were  the  nerve  impulses  still  flow- 
ing along  the  nerves  as  during  our  waking  hours,  there  would 
be  no  relaxation  during  sleep,  and  the  organs  would  never 
rest. 

Fatigue,  which  is  present  at  the  end  of  the  day,  is  simply, 


176 


SPINAL  ADJUSTMENT 


Fig.  39. 

PosTEUioR  Aspect  of  Spine. 

(A)  Lateral  displacement  of  the  second  dorsal  vertebra   to  the  left. 

(B)  Lateral  displacement  of  the  eighth  dorsal  vertebra  to  the  right. 

(C)  Compression  of  the  left  side  of  the  disc  between  the  twelfth  dorsal  and 
first  lumbar  vertebrae  resulting  in  a  tilting  of  the  twelfth  dorsal. 

(D)  Inferior  displacement  of  the  third    lumbar   vertebra    due    to    tliinninj;   of 
the  posterior  portion  of  the  disc  between  it  and  the  fourth  lumbar  vertebra. 


VERTEBRAL  MAL-ALTGNMENT 


177 


Fig.  40. 

Lateual  Aspect  of   Spine. 

(A  and  B)  The  anterior  portion  of  the  lntervertel>ral  disc  is  thinned,  and  as  a 
result  of  the  approximation  of  the  vertebrae  the  intervertebral  foramina  are 
encroached  upon  by  the  displaced  articular  processes. 

(C,  D,  and  E)  The  discs  between  these  vertebrae  are  thinned  and,  owing  to 
the  approximation  of  the  vertebrae,  the  vertical  diameter  of  the  corresponding 
intervertebral  foramina  is  diminished. 

(P)  The  fourth  lumbar  vertebra  is  displaced  posteriorly  and  encroaches  on 
the  antero-posterior  diameter  of  the  intervertel)ral  foramen  below. 


178  SPINAL  ADJUSTMENT 

therefore,  the  result  of  exhaustion  of  the  nerve  centres.  We 
retire  at  night,  exhausted,  and  awaken  in  the  morning,  re- 
freshed. The  various  minor  vertebral  lesions  produced  dur- 
ing the  previous  day,  by  the  numerous  external  and  reflex  in- 
fluences with  which  we  were  brought  into  contact,  were  spon- 
taneously adjusted.  A  normal  flow  of  impulses  along  the 
nerves  is  the  result,  and  the  effect  of  these  impulses  is  perfect 
function,  balanced  metabolism,  an  equalized  circulation  of 
the  blood,  and  perfect  muscular  tonicity.  Were  these  bodily 
activities  at  all  times  in  the  state  of  balanced  perfection  that 
they  are  in  the  morning,  we  would  never  become  exhausted, 
since  the  anabolic  processes  would  compensate  for  the  cata- 
bolic  effects. 

But  we  are  not  yet  adapted  to  our  present  mode  of  living, 
and  cannot  successfully  cope  with  the  disadvantages  which  it 
entails.  The  air  we  breathe,  the  positions  which  our  occupa- 
tion makes  necessary,  the  food  which  we  eat,  and  all  the 
deleterious  influences  of  our  more  or  less  artificial  life  act 
as  reflex  causes  of  minor  vertebral  lesions,  by  disturbing  the 
balance  of  muscular  laxity  and  rigidity. 

As  a  result  of  these  influences,  various  subluxations  occur. 
Metabolism  is  disturbed,  organs  do  not  functionate  harmoni- 
ously, the  poisonous  products  of  muscular  activity  begin  to 
accumulate,  the  activity  of  the  skin  is  diminished,  and  gen- 
eral exhaustion  ensues. 

Sleep  then  comes,  and  while  the  body  is  completely  re- 
laxed during  this  period  of  rest,  the  subluxations  are  spon- 
taneously adjusted,  and  normal  conditions  are  restored. 

It  was  stated  above  that  certain  subluxations  may  be  so 
severe  that  it  is  not  possible  for  nature  to  correct  them  spon- 
taneously. These  more  marked  subluxations,  which  are  the 
result  of  traumatisms,  as  a  rule,  then  become  a  cause  of 
disease.  It  is  with  these  innumerable  minor  vertebral  injuries 
that  we  have  to  deal. 


CHAPTER  III 

The  External  Causes  of  Vertebral  Mal-Alignment 

The  etiological  factors  in  the  production  of  vertebral  sub- 
luxations are  generally  very  imperfectly  understood.  That 
they  exist  is  freely  conceded  by  those  who  have  investigated 
the  subject.  A  simple  palpation  of  the  vertebral  column  by 
one  trained  for  the  work  will  reveal  the  existence  of  subluxa- 
tions in  most  sick  people.  Further,  the  fact  that  after  a  proper 
adjustment  the  same  conditions  no  longer  obtain,  proves 
rather  conclusively  that  subluxations  of  the  vertebrae  are  not 
"myths." 

A  fact,  however,  which  is  little  understood,  even  by  prac- 
titioners of  spinal  adjustment,  and  a  question  concerning 
which  arises  in  the  minds  of  practitioners  in  other  branches  of 
the  healing  art,  is:  How  are  these  displacements  produced ?- 
Certainly,  a  force  of  some  kind  must  be  brought  to  bear  upon 
the  vertebrae  or  their  supporting  structures,  the  muscles  and 
ligaments,  to  bring  about  the  subluxation. 

That  we  are  constantly  beset  by  circumstances  which  may 
produce  subluxations  of  vertebrae  was  shown  in  the  previous 
chapter.  When,  however,  an  unusual  or  a  continuous  force 
is  brought  to  bear  upon  a  certain  region  of  the  spine,  a  perma- 
nent subluxation  is  produced. 

From  a  mechanical  standpoint,  every  force,  and  by  that 
term  is  included  everything  connected  with  our  environment, 
has  its  influence  upon  the  spine  which  is  the  central  axis,  or, 
as  it  has  been  termed,  the  "line-shaft"  of  the  body.  Every 
jar,  fall,  twist,  jolt,  etc.,  to  which  the  body  is  subjected,  if  it 
is  excessive,  and  overcomes  the  elasticity  of  the  intervertebral 
discs  and  the  tonicity  of  the  ligaments,  will  result  in  a  sub- 
luxation. 

The  External  Causes  of  Subluxations. — The  chief  external 
factors  in  the  production  of  vertebral  subluxations  may  be 
classified  as  follows: 

179 


180  SPINAL  ADJUSTMENT 

1.  Occupation. 

2.  Habits. 

3.  Injuries. 

4.  Age. 

5.  Exhaustion. 

Vertebral   Subluxations   Produced   by   Occupation. — That 

certain  forms  of  occupation  predispose  to  various  lesions  of 
the  vertebral  column  cannot  be  doubted.  The  slightest  knowl- 
edge of  mechanics  will  make  this  fact  plain.  It  is  physically 
impossible  to  assume  a  constant  position,  day  after  day,  with- 
out some  permatient  change  in  the  conformity  of  the  parts 
which  are  thus  changed,  taking  place. 

This  factor  in  the  production  of  vertebral  subluxations 
coincides  with  undeniable  certainty  with  the  occupational 
diseases  as  generally  recognized.  For  example :  the  upper 
thoracic  segments  of  the  vertebral  column  control  the  heart 
and  lungs ;  accountants,  book-keepers,  clerks,  compositors, 
printers,  bench-workers,  dressmakers,  tailors,  and  milliners, 
by  the  position  which  they  assume  at  their  work,  produce  a 
spinal  curvature  in  the  upper  thoracic  region  of  the  spine ; 
and  it  is  well  known  that  in  these  persons  asthma,  tuberculosis, 
and  cardiac  diseases  are  most  prevalent.  It  is  therefore  be- 
cause of  the  subluxations  incident  to  their  occupation  that 
these  diseases  prevail  in  individuals  following  these  occupa- 
tions. 

Those  who  follow  sedentary  occupations,  having  very 
little  exercise,  and  working  in  situations  where  the  air  is 
vitiated,  are  susceptible  to  gastro-intestinal  diseases,  diseases 
of  the  respiratory  system,  and  numerous  nervous  disorders. 
Owing  to  the  deficient  amount  of  exercise  which  these  per- 
sons take,  the  tonicity  of  the  muscular  system  becomes  im- 
paired, and  subluxations  are  easily  induced.  Sedentary  po- 
sitions cause  especially  compression  subluxations  of  the  ver- 
tebrae in  the  lower  dorsal  and  upper  lumbar  region,  resulting 
in  a  deficient  amount  of  nerve-impulses  to  the  intestinal  tract ; 
as  a  result  constipation,  hemorrhoids  (through  sluggish  cir- 
culation), etc.,  develop.  Coincident  with  this,  there  is  a  stoop- 
ing forward,  tending  to  a  backward  displacement  of  the  cer- 
vical and  upper  dorsal  vertebrae,  which  may  inaugurate  many 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  181 

disorders,  depending  upon  the  segment  of  the  spine  which  is 
involved. 

In  those  who  follow  occupations  to  which  violent  exercise 
is  incident,  subluxations  of  vertebrae  are  often  directly  pro- 
duced, as  for  example,  in  those  obliged  to  carry  heavy  weights, 
wrestlers  and  athletes  in  general,  etc. 

The  above  few  generalizations  serve  to  show  the  impor- 
tance of  occupation  in  the  production  of  vertebral  subluxations. 
It  would  be  manifestly  impossible  to  give  in  detail  each  occu- 
pation, with  a  list  of  the  diseases  incident  to  such  occupation, 
and  the  manner  in  which  the  subluxations  are  produced,  and 
bear  a  definite  relationship  to  the  diseases  present.  In  every 
case,  however,  it  should  be  ascertained  whether  the  occupa- 
tion is  active  or  sedentary,  or  if  the  patient  is  subjected  by  his 
occupation  to  deleterious  influences  of  any  kind.  Reflex  sub- 
luxations, which  will  be  considered  in  the  following  chapter, 
are  frequently  produced  as  a  result  of  some  factor  in  connec- 
tion with  the  occupation.  For  example,  the  handling  or 
breathing  of  toxic  or  irritating  substances  will  reflexly  pro- 
duce subluxations.  Thus  engravers,  potters,  painters,  dyers, 
etc.,  by  inhaling  dust-particles  and  gases,  induce  an  irritative 
condition  of  the  bronchial  mucous  membrane ;  this  irritation 
excites  the  nerve-endings  in  this  region,  and  the  reflex  action 
produced  at  the  corresponding  spinal  segment  is  expressed 
on  the  musculature  of  that  segment ;  the  resultant  contraction 
of  these  muscles  ultimately  produces  a  displacement  of  the 
vertebrae. 

Vertebral  Subluxations  Produced  by  Habits. — Habits, 
especially  those  referring  to  the  assuming  of  incorrect  atti- 
tudes, are  a  prolific  source  of  subluxations.  The  most  com- 
mon example  of  this  that  could  be  cited  is  the  posture  assumed 
by  school-children,  in  whom  almost  every  form  of  spinal  dis- 
placement is  thus  produced,  resulting  in  disorders  of  every 
description,  depending  upon  the  segment  of  the  spine  which 
is  especially  involved. 

Vertebral  Subluxations  Produced  by  Injuries, — The  ver- 
tebral column  being  the  axis  of  the  body,  a  force  applied  from 
any  direction  will  be  transmitted  to  the  spine,  and  cause  a 
more  or  less  serious  displacement  of  a  vertebra.  This  may 
be  corrected  immediately,  and  no  harmful  results  follow  the 


182  SPINAL  ADJUSTMENT 

momentary  impingement  of  the  nerve  passing  through  the 
narrowed  intervertebral  foramen  of  the  affected  spinal  seg- 
ment. Or  the  subluxation  may  remain  until  the  individual  is 
relaxed  in  sleep,  and  be  then  spontaneously  adjusted.  How- 
ever, if  the  displacement  is  marked,  and  a  pronounced  rigidity 
of  the  vertebral  ligaments  is  present,  the  impinged  nerve, 
whose  branches  supply  the  vertebral  ligaments  in  that  area,  is 
prevented  from  sending  to  these  ligaments  the  impulses  neces- 
sary to  the  preservation  of  the  balanced  tonicity  of  the  corre- 
sponding sides  of  the  vertebral  column.  As  a  result  of  this 
condition,  the  subluxation  is  neither  corrected  at  once,  nor 
during  the  period  of  complete  relaxation  of  the  individual  in 
sleep,  but  persists.  As  a  consequence  of  the  interference  with 
the  sympathetic  fibres,  vasomotor  disturbances  arise;  the  ves- 
sels are  dilated,  and  a  reaction  of  inflammation  ensues.  A 
greater  or  less  organization  of  the  products  of  inflammation 
now  follows,  forming  adhesions,  and  the  subluxation  remains 
in  a  fixed  position.  Only  mechanical  means,  properly  directed, 
will  now  suffice  to  adjust  the  displaced  vertebra  to  its  proper 
position. 

It  may  now  be  asked,  granted  that  mal-alignment  of  the 
vertebrae  may  be  brought  about  in  the  manner  above  de- 
scribed, do  these  causes  occur  as  frequently  as  they  necessarily 
must  to  coincide  with  the  claim  that  most  diseases  are  directly 
or  indirectly  produced  by  this  factor? 

If,  as  maintained  by  advocates  of  spinal  adjustment,  most 
diseases  are  due  to  subluxations  of  the  vertebrae,  producing 
impingement  of  nerves,  and  preventing  their  proper  conduc- 
tion of  impulses,  then  the  personal  history  of  nearly  all  pa- 
tients should  cite  the  occurrence  of  some  injury.  Now, 
although  the  author  shows  that  direct  injury  is  only  ane 
etiological  factor  in  the  production  of  subluxations,  if  the 
personal  history  of  all  patients  examined  is  carefully  and 
studiously  investigated,  it  is  surprising  what  a  great  number 
show  that  some  form  of  injury  has  been  received  at  some 
time.  The  truth  of  this  assertion  was  proven  by  looking  over 
the  case  records  of  the  clinical  department  of  the  National 
School  of  Chiropractic,  in  which  it  was  found  that  78%  of-  all 
examined  showed  mention  of  a  recent  injury. 

Very  often,  these  injuries  left  no  immediate  after-effects 


CAUSES  OF  VERTEBRAL  M AL-ALIGNMENT  183 

sufficient  to  fix  a  lasting  impression  on  the  patient's  mind. 
Many  patients,  also,  do  not  associate  the  previous  injury  with 
their  present  complaint,  and  thus  fail  to  mention  it  when  in- 
quiry is  made. 

Works  on  diagnosis  all  mention  the  fact  that  in  taking  the 
patient's  history  full  information  regarding  previous  injuries 
should  be  elicited.  Practitioners  in  general,  however,  do  not 
seem  to  have  regarded  previous  injuries  as  a  very  important 
factor  in  the  production  of  disease,  and  very  little  attention 
has  been  paid  to  this  etiological  factor. 

On  the  other  hand,  the  patient's  mind  is  so  engrossed  with 
his  present  symptoms,  that  he  has  no  thought  of  any  previous 
injury,  which  may,  as  a  matter  of  fact,  date  back  ten  or  twenty 
years. 

When  we  remember,  in  addition  to  this,  that  jars,  falls, 
blows,  strains,  twisting,  and  other  similar  forms  of  traumatism 
may  be  so  slight  as  to  receive  no  consideration  by  the  patient, 
and  yet  produce  subluxation  of  a  vertebra,  we  see  how  easily 
the  connection  may  be  lost  sight  of.  Therefore,  when  after 
careful  questioning  of  the  patient,  no  history  of  a  previous 
injury  can  be  obtained,  the  possibility  still  remains  that  one 
may  nevertheless  have  been  suffered.  However,  if  the  patient 
be  persistently  questioned  on  this  point,  he  will  often  finally 
recall  a  previous  injury  of  some  kind.  We  can  readily 
demonstrate  this  on  ourselves  by  trying  to  recall  ofif-hand 
all  the  injuries  which  we  have  sustained  during  our  own 
lifetime. 

Jars  produce  subluxations  by  causing  a  thinning  of  the 
intervertebral  cartilaginous  discs ;  thus  railroad  men  are  af- 
fected by  certain  diseases  incident  to  a  settling  of  the  spine 
in  the  lumbar  region,  popularly  known  as  "railroad  spine." 
This  same  term  is  also  used  to  describe  a  neurasthenic  condi- 
tion following  and  persisting  after  injuries  or  shake-ups,  like 
railway  accidents. 

Falls,  sometimes  of  the  slightest  severity,  may  injure  the 
muscles  and  ligaments  of  the  vertebral  column,  resulting  in  a 
contraction  of  the  muscles  and  ligaments  of  the  region  af- 
fected. Thus  numerous  cases  can  be  traced  back  directly  to  a 
fall  received  years  previously. 

Blows  which  cau^^e  an  injury  of  the  ligaments  and  muscles 


184  SPINAL  ADJUSTMENT 

of  the  spine,  will  cause  contraction  of  these  muscles  and  liga- 
ments, for  the  reason  that  traumatism  of  such  structures 
causes  them  to  become  contracted.  This  can  be  easily  demon- 
strated by  striking  the  biceps  with  the  ulnar  surface  of  the 
hand ;  the  local  contraction  of  the  muscle  which  follows  is 
identical  with  that  which  occurs  in  vertebral  subluxations  ex- 
cept that  in  the  latter  case  the  contractured  condition  is  more 
apt  to  be  permanent.  The  lack  of  balance  thus  induced  draws 
the  vertebra  toward  the  side  of  the  contraction,  and  the  lesion 
persists  until  relieved  by  mechanical  means.  Reflex  sub- 
luxations may  also  be  caused  by  blows  which  irritate  or  in  any 
way  excite  peripheral  nerve-endings. 

Strains  of  moderate  severity,  which  cause  a  tearing  of 
some  of  the  muscular  and  ligamentous  fibres  which  hold  the 
vertebrae  in  proper  position,  will  also  produce  subluxation 
thereof.  Should  the  strain  be  of  even  slight  severity,  the  irri- 
tation of  the  muscles  and  ligaments  will  of  itself  be  sufificient 
to  cause  a  subluxation  as  a  result  of  the  contractured  condi- 
tion produced  by  the  injury.  Strains  are  produced  in  a  great 
variety  of  ways,  and  depending  upon  the  region  of  the  spine 
afifected  will  be  the  disturbances  resulting  from  the  impinge- 
ment of  the  structures  passing  through  the  intervertebral 
foramen  which  is  involved.  The  simplicity  with  which  such 
strains  may  sometimes  be  received  are  out  of  all  proportion 
to  the  severity  of  the  disorders  which  result,  and  these  injuries 
should  never  be  overlooked.  Many  cases  are  known  in  which 
a  strain  so  slight  at  the  time  of  its  occurrence  as  to  receive 
scarcely  any  attention,  resulted  in  disorders  of  the  greatest 
gravity,  which  were  relieved  entirely  within  a  short  time  after 
adjustment  of  the  vertebra  which  was  displaced. 

Twisting  of  the  spine,  other  than  that  which  would  come 
under  the  head  of  sprains,  are  a  prolific  source  of  vertebral 
subluxations.  These  have  already  been  referred  to  under 
the  head  of  habits,  occupations,  etc.  Abnormal  posi- 
tions of  the  spine,  if  maintained  for  a  sufficient  length  of  time, 
will  ultimately  produce  changes  in  the  bones  and  ligaments 
composing  it.  The  intervertebral  discs  will  become  thinner 
on  one  side  and  remain  thicker  on  the  other;  the  ligaments 
will  become  shorter  on  one  side  and  longer  on  the  other. 
Finally  the  vertebrae  are  permanently  out  of  their  proper 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  185 

alignment,  and  the  impingement  of  the  nerves  which  follows 
leads  to  numerous  and  varied  disorders. 

Vertebral  Subluxations  Produced  by  Age. — As  the  declin- 
ing years  of  life  come  on,  the  vertebral  column  gradually  be- 
comes shortened,  settled,  and  less  straight.  This  diminution 
in  the  length  of  the  spinal  column  is  principally  at  the  ex- 
pense of  the  intervertebral  discs.  Each  day,  as  a  result  of 
muscular  exhaustion,  there  is  a  certain  loss  in  height.  It 
has  been  shown  that  the  average  individual  is  from  one-half 
to  one  inch  shorter  in  the  evening  than  he  was  in  the  morning 
of  the  same  day.  During  youth,  when  rest  and  relaxation 
are  perfect,  and  the  elasticity  of  the  tissues  is  marked,  the 
settling  of  the  spine  which  occurred  during  the  day  is  en- 
tirely corrected  during  sleep.  As  age  comes  on,  however, 
and  rest  and  relaxation  are  imperfect,  and  the  tissues  are 
becoming  less  elastic,  there  is  an  incomplete  return  to  the 
normal  length  of  the  spine,  and  gradually  the  shortening 
incident  to  old  age  comes  on.  Necessarily  the  deficiency  in 
the  amount  of  expansion  which  occurs  during  the  night  to 
compensate  for  the  settling  that  occurs  during  the  day,  is 
exceedingly  slight.  But  with  the  advancing  years  these 
differences  becomes  more  and  more  apparent.  As  the  inter- 
vertebral cartilaginous  discs  become  more  and  more  thinned, 
the  intervertebral  foramina  become  narrowed,  and  the  struc- 
tures which  they  transmit  become  impinged  to  an  increasingly 
greater  degree.  Finally  the  lumen  of  the  intervertebral  fora- 
men is  narrowed  to  one-half  its  normal  size,  and  the  nerves 
are  prevented  from  conducting  the  impulses  necessary  to  the 
proper  function  of  the  parts  which  they  supply.  Functional 
and  organic  disorders  of  various  organs  then  develop.  Secre- 
tion is  deficient,  metabolism  is  disturbed,  and  the  muscular 
structures  lose  their  tone.  Nature  endeavors  to  compensate 
for  this  settling  of  the  spine  in  the  aged  by  causing  it  to  bend 
forward.  This  is  shown  by  examination  of  the  spine  of  an 
aged  person,  when  it  wall  be  seen  that  the  intervertebral 
discs  are  thinned  anteriorly,  and  to  a  less  degree  posteriorly. 
This  compensatory  curve  tends  in  a  rneasure  to  prevent  com- 
plete occlusion  of  the  intervertebral  foramina,  though  not 
wholly  so.  Were  the  settling  of  the  spine  which  accompanies 
old  age  to  be  prevented  from  occurring,  and  it  can  be  pre- 


186  SPINAL  ADJUSTMENT 

vented  to  a  great  extent,  how  many  of  the  disorders  peculiar 
to  this  period  of  Hfe  might  not  be  eliminated? 

Vertebral  Subluxations  Produced  by  Exhaustion. — Fatigue 
as  a  result  of  the  muscular  exhaustion  incident  to  the  exercise 
taken  during  the  day  produces  numerous  vertebral  subluxa- 
tions. As  already  mentioned  these  subluxations  are  usually 
spontaneously  adjusted  during  the  period  of  sleep  when  com- 
plete relaxation  of  the  ligaments  and  muscles  is  present.  The 
settling  of  the  vertebral  column  which  occurs  during  the  day 
causes  a  narrowing  of  the  intervertebral  foramina,  producing 
slight  impingement  of  the  nerves  and  blood-vessels  passing 
through  them.  This  interference  with  the  conductivity  of 
these  nerves  and  with  the  nutrition  of  the  involved  segments 
of  the  spinal  cord  produces  a  general  depression  of  nervous 
tonicity,  which  is  expressed  as  fatigue.  Spinal  adjustment, 
by  restoring  the  normal  size  of  these  foramina,  will  relieve 
the  exhaustion  at  once.  It  w-as  this  fact  which  w^as  the  under- 
lying reason  why  the  Bohemians  who  first  practiced  spinal 
adjustment  obtained  the  results  they  did  by  their  crude  meth- 
ods, although  the  reason  why  such  results  w^ere  obtained  were 
not  understood  by  them. 

The  more  excessive  the  muscular  exhaustion  of  the  day 
is  the  greater  will  be  the  degree  of  settling  of  the  vertebral 
column.  Occasionally,  a  vertebra  may  become  so  seriously 
displaced  as  a  result  of  this  loss  of  muscular  tonicity  that 
spontaneous  adjustment  w^ill  not  take  place.  In  such  an  event 
a  permanent  subluxation  of  the  vertebra  remains.  It  is  very 
often  subluxations  induced  in  this  manner,  as  a  result  of 
excessive  work,  that  produce  various  disorders. 

The  feeling  or  sensation  of  exhaustion,  like  every  other 
sensation  perceived  by  a  living  organism,  is  perceived  in  the 
sensorium  of  the  brain,  and  not  in  the  end  organs  of  the 
nerves.  It  is  by  means  of  the  common  sensations,  of  wdiich 
fatigue  is  an  example,  that  the  individual  is  made  aware  of 
certain  conditions  in  various  parts  of  his  body.  The  sensa- 
tion of  fatigue,  further,  is  a  subjective  sensation,  that  is  to 
say,^  one  which  is  dependent  upon  internal  causes.  Fatigue, 
therefore,  must  be  looked  upon  as  the  sensation  which  tells 
us  that  exhaustion  of  the  body,  either  wholly  or  in  part,  is 
present.     The  sensation  of  exhaustion  is  perceived  when  the 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  187 

nerve-endings  are  irritated  by  the  poisonous  by-products  of 
muscular  activity.  As  a  result  of  the  settling  of  the  spine 
consequent  on  the  lack  of  muscular  tonicity  and  the  thinning 
of  the  intervertebral  discs,  the  venous  flow  from  each  spinal 
segment  is  obstructed,  and  these  poisonous  by-products  have 
a  toxic  influence  upon  the  corresponding  segments  of  the 
spinal  cord.  The  reflex  centres  are  affected,  and  a  want  of 
harmonious  action  between  the  cerebro-spinal  and  sympa- 
thetic divisions  of  the  nervous  systems  results.  If  one  por- 
tion of  the  body  is  especially  exhausted  the  reflex  excitation  of 
its  reflex  centre  is  expressed  upon  the  musculature  of  that 
spinal  segment  and  a  subluxation  results.  In  this  manner 
a  subluxation  may  be  produced  not  alone  by  direct  failure 
of  the  exhausted  muscles  to  hold  the  vertebra  in  its  proper 
position,  but  also  by  a  reflex  motor  impulse  produced  by 
the  toxic  excitation  of  the  reflex  centre  of  the  cord. 


CHAPTER  IV 

The  Internal  Causes  of  Vertebral  Mal-Alignment 

It  is  freely  admitted  that  not  all  diseases  are  produced  by 
lesions  in  the  vertebral  column.  By  some  students  of  Spinal 
Adjustment  the  assertion  has  been  made  that  all  disease  is 
due  to  subluxations  of  the  vertebrae,  and  that  all  disease  is 
curable  by  adjustment  of  displaced  vertebrae.  Such  a  view 
is  erroneous. 

The  main  reason  why  this  opinion  was  formed  is  perhaps 
due  to  the  fact  that  whenever  an  abnormal  condition  obtains 
in  any  part  of  the  body,  a  vertebral  subluxation  may  be  found 
at  the  point  of  emergence  of  the  nerves  which  control  that 
part.  Not  only  that,  but  it  is  true  that  in  most  instances  the 
abnormality  may  be  removed  by  the  adjustment  of  such  a 
subluxation. 

In  view  of  these  facts,  some  practitioners  of  Spinal  Ad- 
justment fail  to  recognize  the  further  fact  that  not  only  may 
such  subluxations  produce  disease,  but  a  pre-existing  disease 
may  produce  a  displacement  of  a  vertebra. 

Some  investigators  of  Spinal  Adjustment  have  taught  that 
diseased  organs  may  reflexly  produce  subluxation  of  vertebrae, 
but  scientific  explanations  of  this  phenomenon  have  been 
wanting,  or,  where  attempted,  have  been  too  involved  and 
complicated  to  be  satisfactory. 

The  exact  manner  in  which  pathological  conditions,  as 
well  as  other  deleterious  influences,  produce  subluxations  is 
reflexly.  The  exact  manner  in  which  this  occurs  will  be 
shown  in  this  chapter. 

The  Reflex  Cycle. — The  first  essential  to  an  understanding 
of  the  reflex  production  of  subluxations  of  the  vertebrae  is  a 
thorough  knowledge  of  the  reflex  cycle.  This  includes  the 
reflex  arc  of  nerves  and  the  reflex  act. 

For  the  performance  of  a  reflex  act  the  following  anatom- 
ical structures  must  exist :  A  receptive  peripheral  nerve- 
ending  ;  an  afferent  path  leading  to  the  cord ;  cells  in  the  cord 

188 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  189 

by  which  the  incoming  impulses  shall  be  there  distributed ; 
and  a  set  of  efferent  nerves  to  carry  the  outgoing  impulses 
to  the  terminal  organ  which  gives  the  response.  The  afferent 
and  efferent  paths  over  which  the  impulses  in  a  reflex  act 
travel  are  (1)  the  sensory  and  motor  fibres  of  the  spinal 
nerves,  associated  in  the  gray  matter  of  the  cord;  (2)  the 
sensory  and  motor  fibres  of  the  cranial  nerves,  which  are 
connected  in  the  brain ;  (3)  the  afferent  spinal  fibres,  the  pos- 
terior longitudinal  bundle,  chiefly,  and  eff'erent  cranial  fibres ; 
(4)  the  afferent  cranial  and  efferent  spinal  nerve  fibres,  the 
two  being  associated  by  the  anterior  longitudinal  bundle,  the 
spinal  root  of  the  fifth  nerve,  the  vestibulo-olivary  and 
vestibulo-spinal  tracts,  the  solitary  bundle,  etc. 

Preceding  a  discussion  of  the  exact  manner  in  which  verte- 
bral subluxations  are  produced  reflexly,  consideration  of  each 
of  the  above  forms  of  reflexes  will  be  taken  up. 

Spinal  Reflexes. — In  the  most  simple  spinal  reflexes  the 
afferent  fibres  of  the  reflex  arc  arborize  about  the  cell-bodies 
whose  branches  constitute  the  efferent  fibres.  Among  them 
are  the  skin  and  muscle  reflexes,  such  as  the  patellar,  the 
gluteal,  and  the  plantar  reflexes,  the  involuntary  withdrawal 
of  a  part  from  a  source  of  irritation,  etc. 

Among  the  more  complex  spinal  reflexes  are  the  cardio- 
accellerator  reflexes,  vaso-motor  reflexes,  micturition,  parturi- 
tion, and  defecation.  As  an  example,  let  us  trace  a  defecation 
reflex:  the  rectum  is  supplied  by  the  third  and  fourth  sacral 
nerves  and  by  branches  from  the  inferior  mesenteric  and 
hypogastric  plexuses.  Irritation  of  the  nerve-endings  in  the 
mucous  membrane  of  the  rectum  is  caused,  normally,  by  the 
presence  of  fecal  matter.  The  impulses  caused  thereby  run 
to  the  special  defecation  center  in  the  lumbar  enlargement  of 
the  spinal  cord,  either  by  way  of  the  sacral  nerves  or  through 
the  sympathetic  plexuses,  the  gangliated  cord,  and  the  rami 
communicantes  to  the  lumbar  nerves,  through  the  posterior 
roots  of  which  they  reach  the  defecation  center  in  the  cord. 

From  the  defecation  center  the  outgoing  impulses  follow 
two  courses :  first,  they  descend  through  the  third  and  fourth 
sacral  nerves  and  cause  inhibition  in  the  circular  fibres  of 
the  rectum  and  contraction  of  the  longitudinal  muscle.  Sec- 
ondly, the  above  action  is  immediately  followed  by  impulses 


190  SPINAL  ADJUSTMENT 

which  pursue  the  sympathetic  course,  through  the  anterior 
roots  of  the  lumbar  nerves,  the  rami  communicantes,  the 
gangliated  cord,  and  the  inferior  mesenteric  and  hypogastric 
plexuses,  to  the  rectum.  They  cause,  in  succession  from  above 
downward,  contraction  of  the  circular  muscle  of  the  rectum. 
The  two  series  of  impulses  thus  open  a  way  for  the  passage 
of  the  fecal  matter,  and  then  force  it  through  the  opening, 
unless  prevented  from  doing  so  by  the  voluntary  contraction 
of  the  external  sphincter  of  the  anus. 

Cranial  Reflexes. — The  simplest  type  of  this  class  of  re- 
flexes are  such  as  spasm  of  the  muscles  of  mastication  as  a 
result  of  a  bad  tooth,  in  which  both  limbs  of  the  reflex  arc  are 
formed  by  the  trifacial  nerve.  Another  example  is  the  facial 
expression  of  pain  also  due  to  the  same  cause,  and  in  which 
case  the  reflex  arc  is  formed  in  addition  by  the  facial  nerve ; 
that  is,  the  impulses  traverse  the  trifacial  nerve  and  by  the 
collaterals  of  its  root-fibres  reach  the  nucleus  of  the  facial 
nerve,  through  which  nerve  they  cause  contraction  of  certain 
muscles  of  expression. 

Examples  of  the  more  complicated  cranial  reflexes  are : 
the  salivary  reflexes  in  which  the  sight  or  smell  of  food 
causes  the  flow  of  saliva ;  coughing,  vomiting,  sneezing,  and 
deglutition  reflexes  are  further  examples.  All  of  these  re- 
flexes can  be  readily  traced  if  a  knowledge  of  the  nerve-supply 
of  the  parts  is  had. 

Spinal  and  Cranial  Reflexes. — Impulses  received  by  the 
spinal  cord  through  the  aft'erent  fibres  of  its  nerves  are 
transmitted  by  the  posterior  longitudinal  bundle  to  the  nuclei 
of  motor  cranial  nerves.  Thus  are  brought  about  movements 
of  the  eyes  toward  the  source  of  the  impulse,  a  change  of 
facial  expression  to  agree  with  the  painful  or  pleasing 
character  of  the  impulses,  etc. 

Cranial  and  Spinal  Reflexes. — There  is  a  great  number  of 
this  class  of  reflexes,  of  which  we  will  note  three  examples: 
First,  in  the  respiratory  reflex,  any  obstruction  or  irritation 
of  the  larynx  or  trachea  sends  an  impulse  through  the  pneu- 
mogastric  nerve  to  its  sensory  nucleus  ambiguous  and  nucleus 
of  the  phrenic  nerve  in  the  cervical  cord,  causing  increased 
respiratory  effort,  coughing,  spasm  of  the  muscles  closing 
the  glottis,   etc.      Second,   the   auditory   reflex   is   illustrated 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  191 

by  the  turnin<^  of  the  head  upon  hearing  a  sudden  sound ;  also 
the  sudden  starting  caused  by  hearing  a  very  loud  sound. 
The  path  for  the  latter  is  probably  as  follows:  The  auditory 
nerve,  the  vestibulo-olivary  and  vestibulo-spinal  tracts,  antero- 
lateral ground  bundle,  and  efferent  fibres  of  spinal  nerves. 
Third,  pupillary  reflexes  belong  to  the  cranial  and  cranio- 
spinal group  of  reflexes.  The  cilio-spinal  centres  are  in  the 
cervical  enlargement  of  the  spinal  cord,  the  pupillo-dilator 
centre  being  in  the  upper  part,  and  the  pupillo-constrictor 
centre  in  the  middle  part  of  that  enlargement.  They  receive 
optic  impulses  through  the  anterior  longitudinal  bundle  from 
the  superior  quadrigeminal  bodies.  The  superior  quad- 
rigeminal  bodies  receive  those  impulses  by  two  routes :  First, 
directly,  through  the  fibres  of  the  external  root  of  the  optic 
tract,  and,  second,  indirectly,  through  centrifugal  fibres  in 
the  optic  radiations,  and  the  superior  brachium.  By  the  lat- 
ter route,  the  optic  impulses  which  have  reached  the  visual 
area  of  the  occipital  lobe,  by  way  of  the  intrinsic  retinal 
neurones  and  the  optic  nerves,  tracts  and  radiations  are  re- 
turned to  the  optic  thalamus  and  external  geniculate  body 
and  then  carried  back  to  the  superior  quadrigeminal  bodies. 
From  there,  reaching  the  cilio-spinal  centres  through  the 
anterior  longitudinal  bundle,  the  impulses  take  one  of  two 
possible  courses :  (a)  They  leave  the  spinal  cord  through 
the  anterior  roots  of  the  upper  thoracic  nerves  and  run,  in 
succession,  through  the  rami  communicantes,  the  cervical 
cord  of  the  sympathetic,  the  cavernous  plexus,  the  ciliary 
ganglion,  and  the  short  ciliary  nerves  to  the  radiating  fibres 
of  the  iris,  producing  dilation  of  the  pupil,  (b)  From  the 
pupillo-constrictor  centre  the  impulses  are  carried  upward  by 
the  posterior  longitudinal  bundle  to  the  nuclei  of  the  motor 
oculi  nerve,  where  they  are  reinforced  by  optic  impulses 
received  directly  through  the  superior  quadrigeminal  body 
and  posterior  commissure.  The  impulses  reach  the  ciliary 
muscle  and  the  circular  muscle  of  the  iris  through  the  motor 
oculi  nerve,  ciliary  ganglion  and  short  ciliary  nerves.  The 
result  is  a  contraction  of  the  pupil  and  accommodation  for 
distance. 

The  Reflex  Act. — The  nervous  mechanism  concerned  in  the 
reflex  act  has   the   following  arrangement:     Afferent   fibres 


192  SPINAL  ADJUSTMENT 

running  from  the  periphery,  and  entering  the  cord  by  way  of 
the  posterior  nerve-roots;  the  central  mass  of  the  spinal  cord 
itself  in  which  these  roots  end,  each  root  marking  the  middle 
of  a  segment;  within  the  cord  and  stretching  its  entire  length 
are  the  central  cells,  interpolated  more  or  less  numerously 
between  the  terminals  of  the  afferent  neurones  and  the  cell- 
bodies  of  the  efiferent  neurones.  From  each  segment  of  the 
cord  go  to  pass  the  anterior  root-fibres,  going  in  part  to  the 
muscles  and  in  part  to  the  ganglia  of  the  sympathetic 
system. 

In  a  reflex  act,  the  response  is  not  accompanied  by  con- 
sciousness. When  an  impulse  enters  the  central  system  by 
way  of  the  posterior  root,  it  is  found  to  follow  the  course  of 
the  afferent  axones  within  the  central  system,  and  thus  must 
be  distributed  ahnost  simultaneously  to  a  length  of  cord  coex- 
tensive with  that  of  the  branches  of  the  afferent  axones.  The 
parts  which  respond  to  the  efferent  impulse  of  the  reflex  act, 
however,  are  those  innervated  from  the  same  segments  of 
the  cord  which  receive  the  sensory  nerves  that  have  been 
stimulated.  Thus  stimulation  of  the  skin  of  the  breast  causes 
movements  of  the  arms.  Still,  wdiile  sensory  impulses  com- 
ing into  any  segment  tend  to  rouse  exclusively  the  muscles 
innervated  by  that  segment,  these  incoming  impulses  are  dis- 
tributed in  the  cord  unevenly  and  in  such  a  way  as  to  easily 
involve  segments  controlling  other  parts  of  the  body.. 

When  the  stimulus  is  applied  on  one  side  of  the  median 
plane,  the  responses  first  appear  in  the  muscles  of  the  same 
side;  and  if  the  stimulus  is  slight,  they  may  appear  on  that 
side  only.  The  incoming  impulses  are  therefore  first  and 
most  effectively  distributed  to  the  efferent  cells  located  on 
the  same  side  of  the  cord  as  that  on  which  these  impulses 
enter. 

In  a  reflex  response  the  strength  of  the  stimulus  is  coex- 
tensive with  the  extent  to  which  the  muscles  are  contracted, 
the  number  of  muscles  taking  part  in  the  contraction,  and  the 
length  of  time  during  which  the  contraction  continues.  A 
single  stimulus  very  rarely,  if  ever,  calls  forth  a  reaction,  if 
the  time  during  which  it  acts  is  very  short,  and  hence  it  is 
supposed  that  there  is  an  accumulation  of  stimuli,  implying 
that  at  some  part  of  the  reflex  pathway  there  is  a  piling  up 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  193 

of  the  effects  of  the  separately  inefficient  stimuli  to  a  point 
at  which  they  ultimately  become  effective. 

The  foregoing  paragraphs  have  been  concerned  mainly 
with  the  changes  occurring  in  the  afferent  portions  of  the 
pathway.  Next  to  be  considered  is  the  efferent  pathway, 
and  we  find  that  the  conditions  for  diff'usion  of  the  outgoing 
impulses  are  dependent  on  the  arrangement  of  several  cells 
in  series.  When  a  group  of  eff'erent  cells  discharges,  we  know 
from  the  arrangement  of  the  anterior  roots  that  the  impulses 
leave  the  cord  mainly  along  the  fibres  which  comprise  these 
roots ;  but  where  the  white  rami  of  the  sympathetic  system 
pass  from  the  spinal  nerves  to  the  ganglia  these  outgoing  im- 
pulses also  pass  over  them,  as  well  as  over  the  few  efferent 
fibres  found  in  the  posterior  root.  These  axones  carrying  the 
outgoing  impulses  have  two  destinations :  (a)  The  voluntary 
or  striped  muscle-fibres ;  (b)  the  sympathetic  nerve-cells  in 
the  ganglia  of  the  gangliated  cord. 

Normally  there  pass  from  the  central  system  along  some 
of  the  nerve-fibres  impulses  which  tend  to  keep  the  muscles 
in  a  state  of  slight  contraction.  Though  the  intensity  of  these 
outgoing  impulses  is  normally  always  small,  still  it  is  subject 
to  significant  variations.  The  difference  between  the  tone 
of  the  muscles  of  an  athlete  in  prime  condition  and  those  of 
a  patient  recovering  from  a  prolonged  and  exhausting  illness 
is  easily  recognized,  and  this  difference  is  in  a  large  measure 
due  to  the  diff"erence  in  the  intensity  of  the  impulses  passing 
out  of  the  cord.  Among  the  insane,  too,  the  variations  in 
this  tonic  condition  follow  in  a  marked  way  the  nutritive 
changes  in  the  central  system,  and  both  facial  and  bodily 
expression  have  a  value  as  an  index  of  the  strength  and  varia- 
bility of  those  impulses  on  which  the  tone  of  the  skeletal  mus- 
cles depends.  This  continuous  outflow  of  impulses  from  the 
central  system  is  indicated  also  by  the  continuous  changes 
within  the  glands,  and  the  variations  in  these  metabolic 
processes  according  to  the  activities  of  the  central  system. 

Since  the  strength  of  the  reflex  responses  depends  upon 
the  strength  and  number  of  stimuli  of  the  afferent  nerve-end- 
ings, it  is  apparent  that  anything  which  causes  the  excitation 
of  these  nerve-endings  by  irritating  them,  and  thus  pro- 
ducing stimuli  which  are  carried  to  the  reflex  centres  in  the 


194  SPINAL  ADJUSTMENT 

cord,  must  be  considered  as  the  prime  causative  factor  in 
the  production  of  whatever  response,  or  action,  follows. 

Take,  for  example,  inflammatory  conditions  with  ulcera- 
tion, as  seen  in  typhoid  fever.  Here  we  would  have,  instead 
of  the  normal  condition  of  the  bowel  cited  above  under  the 
head  of  spinal  reflexes,  the  following  change  in  the  reflex 
act :  Instead  of  a  mild  contraction  of  the  muscles  of  the 
intestinal  wall  there  will  be  a  marked  contraction  of  these 
muscles,  amounting  to  an  actual  spasm,  known  as  tenesmus 
in  the  anus,  and  colic  in  the  intestinal  tract.  This  is  simply 
due  to  the  fact  that  now,  instead  of  mild  and  few  stimuli  to 
the  afferent  nerve-endings,  as  produced  by  the  presence  of 
feces  in  the  bowel,  there  are  violent  and  numerous  stimuli,  as 
a  result  of  the  great  irritation  of  the  mucous  membrane. 

But  a  still  more  important  and  far-reaching  effect  is 
produced. 

The  Diffusion  of  the  Outgoing  Impulses. — In  the  periph- 
eral, system  the  nerve-impulse,  when  once  started  within 
a  fibre  or  axone,  is  confined  to  that  track  and  does  not  diffuse 
to  other  fibres  running  parallel  with  it,  but  it  does  extend  to 
all  the  branches  of  that  axone,  zvhatez'er  their  distribution.  In 
this  physiological  fact  lies  the  key  to  the  mode  of  production 
of  reflex  vertebral  mal-alignments. 

We  have  seen  that  the  outgoing  impulses  pass  over  the 
anterior  root  of  the  spinal  nerve,  over  the  white  ramus  com- 
municans,  and  over  the  efferent  fibres  in  the  posterior  division 
of  the  spinal  nerve.  Since,  as  stated  above,  a  nerve-impulse 
extends  to  all  the  branches  of  the  axone  in  which  it  originates, 
it  follows  that  in  a  reflex  action  the  outgoing  impulse  will 
extend  to  every  branch  of  the  anterior  root  of  the  spinal  nerve, 
of  the  ramus  communicans,  and  of  the  efferent  fibres  in  the 
posterior  division  of  the  spinal  nerve. 

The  posterior  division  of  the  spinal  nerve  is  the  first  di- 
vision given  off  from  it,  and  the  efferent  fibres  in  this  root 
supply  the  musculature  of  the  corresponding  segment  of  the 
vertebral  column.  Consequently  the  first  response  to  the  out- 
going impulse  of  a  reflex  act  will  be  a  contraction  of  the  mus- 
cles of  that  spinal  segment,  for  we  have  seen  that  the  muscles 
that  respond  to  the  eft"erent  impulse  of  a  reflex  act  are  those 
which  are  innervated  from  the  same  segment  of  the  cord  which 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  195 

receives  the  sensory  nerves  that  have  been  stimulated.  Fur- 
ther, the  contraction  of  the  muscles  will  be  on  one  side  only, 
for  we  have  seen  that  all  incoming  impulses  are  distributed 
first  and  most  effectively  to  the  efferent  cells  on  the  same  side 
of  the  cord  as  that  on  which  these  impulses  enter. 

The  action  produced  by  efferent  impulses  depends  upon 
the  character  of  the  tissues  in  which  the  nerve-fibre  which 
conducts  such  an  impulse  ends.  If  it  ends  in  a  gland,  there 
will  be  secretion ;  if  in  a  muscle,  there  will  be  contraction  of 
that  muscle.  In  cases,  therefore,  where  the  posterior  division 
of  the  spinal  nerve  carries  an  outgoing  impulse,  since  it  ends 
in  the  muscles  of  the  spine,  there  will  be  contraction  of  the 
muscles  of  the  spine.  This  contraction  will  be  on  the  same 
side  as  the  sensory  nerves  irritated,  and  will  affect  that  same 
spinal  segment. 

The  Reflex  Production  of  Vertebral  Subluxations. — 
Physiologically,  a  muscle  that  is  repeatedly  stimulated  by 
nerve-impulses  finally  reaches  a  condition  of  tetanic  contrac- 
tion. That  is  to  say,  if  the  impulses  are  continuous,  the  mus- 
cle finally  remains  in  a  permanently  contracted  condition. 
This  naturally  holds  true  also  of  the  muscles  of  the  spine. 
If  a  continuous  flow  of  violent-  outgoing  impulses,  as  a  result 
of  repeated  reflex  acts,  enter  the  muscles  of  a  certain  spinal 
segment,  those  muscles  will  become  permanently  contracted 
on  the  side  affected.  The  muscles  of  the  other  side  remain 
unaffected,  or  are  affected  in  a  much  less  degree. 

The  inevitable  result  of  this  contraction  of  the  muscles  of 
this  side  will  be  to  draw  the  vertebra  toward  that  side.  The 
degree  of  the  displacement  of  the  vertebra  thus  produced  will 
depend  upon  the  severity  of  the  irritation  which  excites  the 
afferent  nerves  concerned  in  the  reflex  act  that  causes  contrac- 
tion of  the  muscles  of  the  involved  segment.  Since  the  per- 
manent contraction  of  the  muscles  necessary  to  the  production 
of  a  vertebral  displacement  depends  upon  repeated  or  marked 
stimulation,  it  follows  that  the  exciting  cause  must  be  present 
for  some  time. 

Returning  to  the  example  already  cited,  namely,  the  re- 
flex contraction  of  the  muscles  of  the  intestines  by  irritation 
of  their  mucous  lining  in  typhoid  fever,  we  note  the  following: 
From  what  was  said  above,  we  know  that  the  efferent  im- 


196  SPINAL  ADJUSTMENT 

pulses  produced  by  the  reflex  act  induced  in  this  way  will 
not  only  affect  the  muscles  of  the  intestines  but  all  other 
muscles  supplied  by  the  spinal  nerve  of  the  same  segment  at 
which  the  sensory  nerve  which  was  stimulated  ends.  There- 
fore, the  muscles  of  the  lower  dorsal  and  upper  lumbar  seg- 
ments of  the  spine  will  be  contracted  whenever  the  intes- 
tines are  affected.  As  a  result  of  this  muscular  contraction, 
there  will  be  a  subluxation  of  a  vertebra  in  these  regions. 
This  is  true  because  the  sensory  nerves  of  the  intestiiies  end 
in  these  segments  of  the  spine. 

Any  disease  which  produces  sufficient  irritation  at  the 
periphery  to  stimulate  the  nerve-endings  and  produce  a  reflex 
act  will,  in  the  manner  described,  produce  a  subluxation  in 
the  same  segment  of  the  vertebral  column  whose  muscles 
are  innervated  by  efferent  nerves  from  the  corresponding 
segment  of  the  spinal  cord  which  receives  the  sensory  nerves 
that  have  been  stimulated. 

That  adjustment  of  these  subluxated  vertebrae  favorably 
influences  the  condition  which  produced  them,  clinical  evi- 
dence bears  out.  It  is  necessary  to  explain  the  exact  manner 
in  which  this  is  brought  about. 

In  the  chapter  dealing  with  the  theoretical  basis  of  chiro- 
practic the  statement  was  made,  that  the  primary  cause  of  a 
large  number  of  diseases  is  subluxations  of  vertebrae.  This 
is  so  by  reason  of  the  fact  that  as  a  result  of  these  subluxations 
the  flow  of  those  impulses  essential  to  the  normal  functional 
activity  and  organic  integrity  of  the  various  parts  of  the  body 
supplied  by  the  impinged  nerves  is  prevented.  The  with- 
drawal of  these  necessary  impulses  creates  in  the  parts  thus 
deprived  a  condition  which  permits  the  development  of 
pathological  processes  in  them.  That  condition  of  the  body, 
or  any  part  of  it,  in  which  perfect  innervation,  and  conse- 
quently perfect  function  and  organic  integrity  obtains,  is 
known  as  "resistance."  It  is  by  virtue  of  this  resistance  that 
the  development  of  disease  processes  is  prevented.  A  lack 
of  such  resistance  constitutes  a  condition  permitting  the 
development  of  disease  processes. 

It  was  stated  that  vertebral  subluxations  thus  become  in 
practically  all  cases  the  primary  and  predisposing  cause  of 
disease  by  producing  the  conditions  which  permit  the  devel- 


CAUSES  OF  VERTEBRAL  MAL-ALIGNMENT  197 

opment  or  continuance  of  a  disease  process.  They  are  not, 
however,  the  direct  cause  of  a  disease,  in  all  cases,  and  here 
we  must  differentiate  carefully  between  the  terms  primary 
and  direct,  and  the  terms  secondary  and  indirect.  To  do  this, 
let  us  take  as  an  example,  typhoid  fever. 

The  first  question  that  naturally  arises  is :  What  is  the 
primary  cause  of  this  disease,  and  what  is  the  direct  cause? 
The  direct  cause,  in  this  case,  is  that  factor  which  directly 
produces  the  disease,  namely  the  typhoid  bacillus.  This 
bacillus  is  not,  however,  the  primary  cause ;  for  by  this  cause 
must  be  understood  that  state  or  condition  of  certain  parts 
which  makes  the  action  of  the  typhoid  bacillus  possible. 
This  primary  cause  is  subluxation  of  vertebrae,  which  by 
producing  a  disturbed  nerve-supply,  and  thereby  diminish- 
ing the  resistance  of  those  parts  for  which  the  typhoid  bacil- 
lus has  a  selective  action,  make  possible  their  activity  in 
those  parts.  Therefore  the  subluxations  are  the  primary 
and  predisposing  cause  of  typhoid  fever,  and  the  typhoid 
bacillus  is  the  direct  cause.  And,  conversely,  the  subluxations 
are  the  indirect  cause,  and  the  typhoid  bacillus  is  the  secondary 
cause. 

This  statement  is  equivalent  to  saying  that  without  a 
spinal  lesion  typhoid  fever  is  impossible,  and  that  is  exactly 
what  is  meant.  Why  is  it  that  of  several  people,  all  of  whom 
are  living  under  the  same  circumstances,  exposed  to  the  iden- 
tical conditions,  eating  and  drinking  the  same  food,  etc., 
some  will  contract  typhoid  fever,  and  others  go  free?  Evi- 
dently it  must  be  because  of  differences  in  their  susceptibility 
to  the  disease.  We  have  seen  that  these  differences  in  sus- 
ceptibility depend  upon  the  nature  of  the  nerve-supply.  And 
a  normal  nerve-supply  depends  upon  a  free  and  uninterrupted 
flow  of  impulses  to  those  parts  of  the  body  at  which  the 
typhoid  bacillus  gains  entrance  to  the  body. 

If,  therefore,  the  innervation  of  the  intestines,  which  are 
the  atrium  of  infection  in  typhoid  fever,  is  abnormal,  the 
disease  will  develop.  Thus  we  see  frequently  that  one  indi- 
vidual who  is  apparently  in  perfect  health  develops  typhoid, 
while  another,  whose  general  health  is  not  nearly  as  perfect, 
goes  free.  This  depends  simply  upon  the  fact  that  in  the 
former  the  atrium  of  infection,  namely  the  intestine,  was  in 


198  SPINAL  ADJUSTMENT 

a  condition  favorable  to  the  entrance  of  the  bacilli,  while  in 
the  latter  such  conditions  did  not  obtain. 

This  is  true  of  all  infectious  and  contagious  diseases. 
What  protects  an  individual  against  the  development  and 
continuance  of  a  disease  is  not  so  much  his  general  state  of 
health,  as  the  condition  of  the  special  area  of  predilection  of 
the  specific  infection.  Resistance  as  maintained  by  perfect 
innervation,  therefore,  prevents  disease,  and,  conversely,  lack 
of  resistance  induced  by  mal-alignment  of  the  vertebrae 
permits  disease. 

To  recapitulate :  Vertebral  subluxations  are  the  primary 
predisposing  and  indirect  factor  in  the  production  of  many 
diseases,  in  which  case  they  have  pre-existed,  and  have  been 
themselves  previously  produced  by  some  external  influence. 
They  are,  secondly,  the  cause  of  the  continuance  of  a  dis- 
ease, having  been  reflexly  fostered  by  the  disease  itself. 
Vertebral  subluxations,  therefore,  are  the  cause  of  the 
production  and  continuance  of  disease. 

Spinal  adjustment,  by  correcting  these  displacements  of 
the  vertebrae,  accomplishes  two  things :  (a)  It  removes  the 
factor  which  makes  it  possible  for  a  disease  to  gain  an  en- 
trance or  foothold  in  the  body ;  (b)  It  restores  normal  nerve- 
impulses  to  parts  deprived  of  them,  and  thus  prevents  the 
continuance  of  the  disease. 


CHAPTER  V 

The  Local  Effects  of  Mal-Alignment  of  Vertebrae 

It  now  remains  to  be  shown  what  the  immediate  and  re- 
mote effects  of  subkixations  of  vertebrae  are.  By  the  immedi- 
ate effects  are  meant  the  influence  upon  the  structures  passing 
through  the  intervertebral  foramen.  By  the  remote  effects 
are  meant  those  which  occur  in  the  parts  of  the  body  suppHed 
by  the  structures  so  influenced. 

That  subluxations  sufficient  to  produce  pressure  upon  the 
nerves  and  vessels  passing  through  the  intervertebral  foramen 
may  occur,  and  frequently  do  occur,  has  been  demonstrated. 
That  this  pressure  will  prevent  the  conduction  of  the  nerve- 
impulses  which  control  the  functional  activity  and  the 
organic  integrity  of  all  parts  of  the  body,  has  also  been  shown. 

From  the  above,  it  can  be  readily  deducted  what  the  ef- 
fects in  any  given  case  will  be,  once  the  subject  of  localiza- 
tion of  segmental  lesions  is  understood.  Such  special  effects 
will  be  considered  in  detail  further  on.  In  this  chapter  we 
will  confine  ourselves  to  a  discussion  of  the  general  effects 
of  vertebral  subluxations. 

The  Local  Effects  of  Vertebral  Subluxations. — When  a 
vertebra  becomes  shifted  from  its  normal  position,  its  relative 
position  to  the  vertebra  above  and  below  it  is  altered  in  all  its 
parts.  A  change  in  the  position  of  the  margins  of  the  inter- 
vertebral foramen  occurs,  and  the  displaced  wall  presses  on 
the  following  structures  which  pass  through  the  foramen : 

Afferent  and  Efferent  Spinal  Nerves. 

White  and  Gray  Rami  Communicantes  of  the  Sympa- 
thetic. 

Arteries  and  Veins. 

Lymphatics. 

Necessarily  every  structure  that  passes  through  the  fora- 
men is  impinged  upon,  and  we  will  now  consider  the  general 
effects  of  pressure  upon  each  of  these  structures. 

199 


200  SPINAL  ADJUSTMENT 

Effect  of  Pressure  on  the  Afferent  Spinal   Nerve. — The 

afferent  fibres  of  the  spinal  nerve  pass  in  the  sheath  of  the 
spinal  nerve  to  the  cord.  Here  a  reflex  arc  is  established 
and  impulses  from  the  periphery  are  transferred  to  an  out- 
going fibre,  and  efferent  impulses  pass  to  the  periphery.  A 
vertebral  subluxation  will  prevent  the  passage  of  the  ingoing 
impulses  to  the  cord,  along  the  afferent  nerves,  and  will  there- 
fore prevent  the  reflex  act  which  occurs  in  the  involved  seg' 
ment,  under  normal  conditions,  from  taking  place.  As  a  result, 
the  efferent  impulses  to  the  tissues  supplied  by  that  segment 
are  not  generated.  As  an  example  of  this  effect,  we  may 
consider  the  patellar  reflex :  If  the  afferent  nerve  is  impinged 
at  the  intervertebral  foramen,  in  the  second  lumbar  segment, 
the  knee-jerk  will  be  absent. 

Effect  of  Pressure  on  the  Efferent  Spinal  Nerve. — An  im- 
pingement on  the  efferent  fibres  of  the  spinal  nerve  will  pre- 
vent the  conduction  of  all  outgoing  impulses  to  the  tissues 
supplied  by  the  affected  nerve.  If,  for  example,  the  fourth 
cervical  nerve  is  impinged,  a  poor  quality  of  saliva  is  secreted 
and  indigestion  finally  develops. 

Effect  of  Pressure  on  the  White  Rami  Communicantes. — 
It  will  be  recalled  that  the  white  rami  of  the  sympathetic 
system  pass  through  the  intervertebral  foramen  in  the  sheath 
of  the  spinal  nerve  to  the  ganglia  of  the  gangliated  cord. 
They  therefore  are  also  impinged  by  subluxation  of  a  vertebra. 
Their  function,  which  is  the  conduction  of  efferent  impulses 
from  the  brain  and  spinal  cord  to  the  ganglia,  and  thence  to 
the  various  tissues,  is  interfered  with.  The  action  of  the 
sympathetic  system  is  thus  disturbed,  and  a  lack  of  balance 
in  the  harmonious  action  of  the  various  systems  of  the  body 
ensues.  These  disturbances  vary  according  to  the  segment 
of  the  spinal  column  which  is  involved,  and  will  be  considered 
later. 

As  an  example  of  the  results  of  pressure  on  the  white  rami 
we  may  assume  that  a  subluxation  exists  at  the  fourth  dorsal 
vertebra.  This,  by  producing  pressure  on  the  spinal  nerve, 
results  in  torpidity  of  the  liver.  The  function  of  the  liver 
is  controlled  especially  by  the  sympathetic  system,  and 
interference  with  the  conduction  of  impulses  to  this  organ 
invariably  results  in  a  disturbance  of  its  function. 


MAL-ALIGNMENT  OF  VERTEBRAE  201 

Effect  of  Pressure  on  the  Gray  Rami  Communicantes. — 

The  gray  rami  of  the  sympathetic  system  pass  to  the  spinal 
cord  from  the  ganglia,  in  the  sheath  of  the  spinal  nerve. 
Hence  they  also  are  subject  to  impingement  in  the  event  a 
vertebra  becomes  subluxated.  These  filaments  govern  the 
nutrition  of  each  corresponding  segment  of  the  spinal  cord, 
and  complete  the  reflex  arc  through  which  the  necessary 
efferent  impulses  are  generated. 

If,  for  example,  the  lower  dorsal  or  upper  lumbar  vertebrae 
are  subluxated,  the  afferent  impulses  are  intercepted  at  this 
point.  The  intestinal  tract  is  influenced  by  the  white  and 
gray  rami  in  this  region.  Any  change  in  the  nature  or  amount 
of  the  intestinal  contents  excites  an  afferent  impulse  in  the 
endings  of  the  afferent  nerves  in  the  intestinal  walls.  When 
the  reflex  arc  is  intact,  an  efferent  or  motor  impulse  is  gen- 
erated, which  is  transmitted  to  the  muscular  coat  of  the  in- 
testines, causing  them  to  evacuate  their  contents.  If  this  re- 
flex arc  is  not  intact,  in  other  words,  if  an  impingement  of  the 
gray  rami  communicantes  is  present,  the  necessary  efferent 
impulses  which  move  the  bowels  to  action  is  wanting.  It  is 
this  fact  which  operates  in  the  production  of  constipa- 
tion. It  is  for  this  reason  that  adjustment  of  the  lower 
dorsal  and  upper  lumbar  vertebrae  invariably  relieves  chronic 
constipation. 

Effect  of  Pressure  on  the  Arteries. — As  previously  shown, 
faulty  nutrition  of  the  nerve-centres,  through  deficient  blood- 
supply,  rapidly  reduces  their  irritability.  The  arteries  which 
pass  through  the  intervertebral  foramen  in  the  sheath  of  the 
spinal  nerve  assist  in  supplying  nourishment  to  the  corre- 
sponding spinal  segments.  Impingement  of  these  arteries 
reduces  the  blood-supply  of  this  segment  of  the  spinal  cord. 
The  effect  of  this  is  a  diminution  or  total  absence  of  irrita- 
bility of  that  segment,  and  a  consequent  break  in  the  reflex 
arc.  As  a  result  the  nerve-supply  of  the  parts  controlled 
by  this  segment  is  not  forthcoming  and  various  disorders 
ensue. 

As  an  example  of  the  manner  in  which  such  a  condition 
brings  about  abnormalities,  the  following  may  be  cited: 
When  the  continuous  flow  of  nerve-impulses  is  impeded,  as 
it  is  in  a  case  of  this  kind  where  the  irritability  of  a  spinal 


202  SPINAL  ADJUSTMENT 

segment  is  diminished,  muscular  tonicity  will  become  abnor- 
mal. For  example,  a  subluxation  in  the  lumbar  region,  by- 
producing  an  anemia  of  the  spinal  segment  of  the  region 
involved,  may  cause  the  muscles  and  ligaments  of  the  arch 
of  the  foot  to  become  so  relaxed  that,  with  other  factors 
entering,  flat-foot  may  result. 

Effect  of  Pressure  on  the  Veins. — The  veins  which  pass 
out  through  the  intervertebral  foramen,  in  the  sheath  of  the 
spinal  nerve,  may  also  be  occluded  when  a  subluxation  exists. 
Since  these  veins  convey  the  venous  blood  from  each  corre- 
sponding segment  of  the  spinal  cord,  obstruction  of  the 
venous  flow,  by  pressure  upon  the  vein,  will  result  in 
congestion  of  that  segment. 

EfTect  of  Pressure  on  the  Lymphatics. — The  lymphatics 
which  pass  through  the  intervertebral  foramina  have  much 
to  do  with  the  metabolism  of  each  segment  of  the  spinal 
cord.  Any  interference  with  this  function,  as  a  result  of  a 
subluxation  obstructing  the  lymphatic  channels,  will  alter 
the  excitability  of  that  segment,  and  the  conduction  of 
impulses,  both  afiferent  and  eflferent,  is  impaired. 


CHAPTER  VI 

The  Effect  of  Vertebral  Subluxations  on  Nerve  Function 

The  effects  of  vertebral  subluxations  on  the  function  of 
nerves  necessarily  depend  upon  the  location  of  the  lesion  to 
a  large  extent.  These  will  be  taken  up  in  the  chapter  deal- 
ing with  segmentation  and  localization.  In  this  chapter  the 
effects  of  vertebral  mal-alignment  on  nerve  functions  in  gen- 
eral will  be  considered,  and  examples  illustrating  each  form 
of  abnormal  nerve  action  will  be  given.  The  reader  is  re- 
ferred in  this  connection  to  the  chapters  dealing  with  the 
function  of  the  nervous  system,  a  thorough  knowledge  of 
which  will  make  what  follows  clearer. 

Effect  of  Vertebral  Subluxations  on  Resistance. — We  have 
fully  explained  how  vertebral  subluxations  must  be  con- 
sidered as  being  the  primary  and  indirect  cause  of  infectious 
and  contagious  diseases.  Since  normal  innervation  implies 
a  perfect  state  of  resistance,  it  follows  that  mal-alignments 
of  vertebrae,  by  obstructing  the  flow  of  impulses  to  a  part, 
diminish  this  resistance. 

It  has  recently  been  conclusively  shown  that  rheumatic 
fever  is  the  result  of  the  entrance  of  the  infective  organism 
through  the  tonsils.  Diseased  tonsils  are  an  ideal  culture 
medium  for  the  growth  and  multiplication  of  these  germs,  and 
the  elaboration  of  their  toxins,  which  enter  the  body  from 
this  point.  If,  therefore,  this  atrium  of  infection  is  in  such 
a  state  that  it  will  not  harbor  these  micro-organisms,  but 
destroys  them,  rheumatic  fever  becomes  impossible  of  devel- 
opment. A  subluxation  in  the  fifth  and  sixth  cervical  seg- 
ments, however,  markedly  alters  the  normal  condition  of 
the  tonsils,  and  they  then  become  a  favorable  medium  for 
the  entrance  of  this  specific  infection.  This  same  principle 
applies  to  all  infectious  and  contagious  diseases. 

Effect  of  Vertebral  Subluxations  on  Movement  and  Sensi- 
bility.— The  influence  of  the  nerves  upon  movement  and  sen- 
sibility is  well  known.     There  is  a  constant  flow  of  nerve- 

203 


204  SPINAL  ADJUSTMENT 

impulses  which  maintains  the  muscles  of  the  entire  body  in  a 
state  of  slight  continuous  contraction.  Every  conscious  and 
unconscious  movement  of  any  part  of  the  body  depends  upon 
the  contraction  of  a  muscle,  and  this  contraction  depends  upon 
an  efferent  impulse  to  the  muscle. 

As  examples  of  interference  with  the  motor  function  of 
nerves  by  mal-alignment  of  vertebrae  may  be  cited  the  action 
of  the  heart,  respiratory  movements,  the  movements  of  the 
stomach  and  intestines,  the  production  of  secretion  by  the 
glands,  etc.  All  these  movements  are  controlled  by  certain 
nerves,  and  a  subluxation,  by  interrupting  the  efferent  im- 
pulses governing  any  of  these  motor  actions,  will  result  in 
abnormal  function  of  the  part  involved.  Thus  a  subluxation 
in  the  upper  cervical  and  upper  dorsal  regions  will  interfere 
with  the  action  of  the  heart.  A  subluxation  in  the  fifth,  sixth 
and  seventh  dorsal  segments  will  interfere  with  the  motility 
of  the  stomach,  and  result  in  indigestion.  A  subluxation  in 
the  lower  dorsal  and  upper  lumbar  region  of  the  vertebral  col- 
umn leads  to  insufficient  intestinal  peristalsis,  and  eventually 
produces  constipation.  A  subluxation  involving  the  fourth 
dorsal  vertebrae  will  result  in  various  disorders  of  the  liver. 
The  etiological  reason  for  this  lies  in  the  fact  that  from  these 
segments  of  the  cord  rise  the  nerves  which  supply  these 
various  organs.  A  diagnosis  of  cardiac  disturbances,  gastric 
disorders,  etc.,  can  be  made  and  confirmed  by  examining  the 
spine  and  locating  these  subluxations.  Naturally,  it  is  im- 
possible to  determine  from  the  spinal  diagnosis  the  exact 
nature  of  the  disorder,  but  that  the  disorder  can  be  referred  to 
a  special  organ,  system  or  part  of  the  body  from  the  spinal 
analysis  alone,  can  be  demonstrated.  The  reason  that  treat- 
ment of  these  conditions  by  spinal  adjustment  produces  the 
desired  results  is  simply  because  it  restores  to  the  affected 
parts  the  nerve-supply  necessary  to  their  motility  upon  which 
their  normal  functioning  depends.  Many  of  the  internal 
viscera  are  supplied  almost  exclusively  by  the  sympathetic 
system,  as  is  shown  by  the  peculiarity  in  the  mode  of  pro- 
duction of  morbid  conditions  in  them.  If  the  body,  for  ex- 
ample, is  exposed  to  cold  and  dampness,  congestion  of  the 
kidneys,  perhaps,  is  produced  on  the  following  day.  Why  not, 
until  the  next  day,  do  these  renal  symptoms  manifest  them- 


VERTEBRAL  SUBLUXATIONS  ON  NERVE  FUNCTION  205 

selves?  Because  as  a  result  of  the  irritation  of  the  peripheral 
nerve-endings  a  reflex  vertebral  subluxation  was  produced  in 
this  particular  individual  in  the  tenth  dorsal  segment;  this 
segment,  governing  the  kidneys  through  the  sympathetic 
system,  is  no  longer  able  to  transmit  impulses  to  the  kidneys 
and  disturbed  circulation  results.  The  reason  that  the  symp- 
toms do  not  follow  until  the  day  after  exposure  to  the  cause, 
is  because  the  motor  properties  of  the  sympathetic  system 
are  exercised  slowly,  as  compared  with  those  of  the  cerebro- 
spinal, in  which  the  effect  of  irritation  of  a  motor  nerve  is 
instantaneous. 

Effect  of  Vertebral  Subluxations  on  Nutrition. — The  effect 
of  subluxations  on  the  trophic  function  of  nerves  is  very  in- 
volved, since  this  term  in  its  broadest  sense  includes  the 
processes  of  digestion,  respiration,  absorption,  secretion, 
excretion,  anabolism,  and  catabolism.  It  is  thus  apparent 
that  a  great  number  of  individual  processes  enters  into  the 
accomplishment  of  that  single  end,  which  we  term  nutrition. 
Since  all  these  processes,  which  make  the  ultimate  nutrition 
of  the  cells  possible,  are  controlled  by  the  nerves,  mal-align- 
ment  of  the  vertebrae,  by  interfering  with  their  normal  exer- 
cise, causes  disturbed  nutrition.  By  some  authorities  it  is 
claimed  that  there  exist  in  all  nerve  bundles  certain  fibres 
which  govern  the  nutrition  of  the  parts  to  which  these  nerves 
go.  If  this  is  true,  a  subluxation  of  a  vertebra  would  directly 
affect  the  trophic  function  of  any  part  of  the  body  supplied 
by  that  segment  of  the  cord  corresponding  to  the  location 
of  the  subluxation.  The  inhibitory  and  augmentor  nerves  are 
generally  considered  as  having  a  trophic  influence  on  the 
parts  which  they  govern.  That  is  to  say,  the  nutrition  of  all 
parts  is  maintained  by  regulating  their  activity ;  during  the 
period  of  inactivity,  the  building-up  or  anabolic  processes 
take  place.  If,  therefore,  the  cardio-inhibitory  nerves  are 
prevented  from  conducting  their  impulses  to  the  heart  mus- 
cle, its  nutrition  will  suffer  since  its  period  of  activity  is 
in  excess  of  its  period  of  rest.  Similarly  the  nutrition  of 
every  part  of  the  body  is  governed  by  the  harmonious  action 
of  the  augmentor  and  inhibitory  nerves.  If  a  subluxation 
interferes  with  the  conduction  of  the  inhibitory  impulses 
which  retard  or  suspend  the  activity  of  an  organ  for  a  suffi- 


206  SPINAL  ADJUSTMENT 

cient    length    of    time    to    permit    the    necessary    reparative 
processes  to  take  place,  its  nutrition  will  necessarily  suffer. 

Effect  of  Vertebral  Subluxations  on  Secretion  and  Ex- 
cretion.— The  processes  of  secretion  and  excretion  are  con- 
trolled by  the  cerebro-spinal  and  sympathetic  nerves,  and  are 
entirely  involuntary.  A  subluxation,  by  interfering  with  the 
conductivity  of  the  nerves,  results  in  changes  in  the  char- 
acter of  the  secretion  and  interference  with  the  functional 
activity  of  the  organ  affected. 

As  examples  of  such  disturbances,  the  following  may  be 
cited :  A  subluxation  of  the  fifth,  sixth,  or  seventh  dorsal 
vertebrae  may  affect  the  secretion  of  the  gastric  juice,  and 
thus  lead  to  indigestion ;  a  subluxation  in  the  upper  cervical 
region  would  also  have  such  an  effect.  A  subluxation  in  the 
upper  cervical  region,  or  affecting  the  fourth  dorsal  vertebra 
would  cause  a  diminished  secretion  of  bile. 

A  constant  flow  of  efferent  impulses  also  governs  the 
secretory  activity  of  certain  glands,  as  those*  which  have  an 
internal  secretion,  for  example,  the  thyroid  gland  and  spleen. 
For  this  reason,  subluxation  of  the  fourth  or  sixth  cervical 
vertebra  results  in  a  depraved  action  of  the  thyroid  gland. 
In  disorders  of  the  spleen  a  subluxation  of  the  ninth  to 
eleventh  dorsal  vertebrae  are  very  often  found. 

The  effect  of  vertebral  subluxations  on  the  function  of 
excretion  is  far-reaching  in  its  effects.  It  is  scarcely  neces- 
sary to  go  into  detail  regarding  the  vast  number  of  affections 
which  may  be  traced  to  a  perverted  function  of  the  excretory 
organs.  The  common  condition,  called  autointoxication  is  a 
very  good  example  of  this  form  of  disturbance  of  nerve 
function. 

The  principal  way  in  which  subluxations  of  vertebrae 
affect  the  functions  of  secretion  and  excretion  is  by  their  in- 
fluence in  preventing  the  flow  of  efferent  impulses  to  those 
organs  concerned  in  these  functions,  by  interrupting  the  mo- 
tor impulses  to  the  secretory  cells.  It  must  be  borne  in 
mind  that  nerves  are  identical  and  so  also  the  impulse.  The 
dift'erent  action  produced  at  their  terminals  depends  upon 
the  nature  of  the  cells  in  which  they  terminate.  ,If  a  nerve 
ends  in  a  muscle,  contraction  of  the  muscle  follows  an  effer- 
ent impulse  to  it.     If  it  ends  in  a  gland  cell,  the  effect  of  an 


VERTEBRAL  SUBLUXATIONS  ON  NERVE  FUNCTION     207 

efferent  impulse  will  be  secretion  or  excretion.  If,  there- 
fore, these  efferent  impulses  are  impeded,  a  deficient  secretory 
activity,  or  excretory  activity,  will  follow  in  those  parts 
supplied  by  the  affected  nerve. 

Effect  of  Vertebral  Subluxations  on  Existing  Action. — 
Subluxations  by  cutting  oft"  the  necessary  impulses  to  a  part 
or  organ  of  the  body  may  cause  it  to  become  overactive.  On 
the  other  hand,  it  may  cause  a  decreased  activity  of  a  part. 

This  is  well  illustrated  by  the  inhibitory  action  of  the 
vagus  upon  the  activity  of  the  heart.  Since  the  vagus  is  con- 
nected with  the  superior  cervical  ganglion  of  the  sympa- 
thetic system,  it  may  be-  influenced  through  the  upper 
cervical  vertebrae.  A  subluxation  in  that  region  of  the  spine 
is  therefore  influential  in  producing  a  rapid  action  of  the 
heart  by  interfering  with  the  inhibitory  action  of  the  vagus 
upon  it. 

Effect  of  Vertebral  Subluxations  on  Temperature. — The 
amount  of  heat  produced  in  the  body  varies  with  the  metabol- 
ism of  the  tissues  of  the  body.  The  amount  of  heat  lost  by 
the  body  depends  upon  the  radiation  and  conduction  of  heat 
from  its  surface,  evaporation  of  water,  respiration,  etc.  The 
normal  temperature  of  the  body  is  maintained  under  the 
varying  conditions  to  which  the  body  is  exposed  by  mechan- 
i.sms  which  permit  variation  in  the  production  of  heat,  and 
variation  in  the  loss  of  heat.  Thus  in  normal  individuals  the 
loss  and  gain  of  heat  are  so  well  balanced  that  a  uniform 
temperature  is  maintained. 

The  influence  of  the  nervous  system  on  the  regulation  of 
temperature  is  very  great.  The  nervous  system,  by  govern- 
ing metabolism,  controls  the  temperature  of  the  body.  By 
its  vaso-motor  influence,  regulating  the  calibre  of  the  blood- 
vessels and  consequently  the  circulation,  it  also  regulates  the 
temperature.  In  addition  to  these  methods  of  regulation  of 
the  temperature  by  the  nerves,  there  is  a  separate  nervous 
apparatus  by  means  of  which  heat  production  and  heat  loss 
are  regulated  as  circumstances  demand.  This  apparatus,  as 
mentioned  in  the  discussion  of  this  subject  under  the  head 
of  the  physiology  of  the  nervous  system,  consists  of  centres 
which  may  be  reflexly  stimulated  by  afferent  impulses  from 
the  skin,  and  which  act  through  special  efferent  nerves  sup- 


208  SPINAL  ADJUSTMENT 

plying  the  various  tissues.  Any  disturbance  of  this  reflex  arc 
will  produce  an  abnormal  temperature. 

So  long  as  the  skin  is  able  to  communicate  to  the  nervous 
centres  the  necessity  of  an  increased  or  diminished  produc- 
tion of  heat,  normal  bodily  temperature  exists.  In  fever, 
then,  there  must  be  come  interference  in  the  ordinary  channel 
by  which  the  skin  is  able  to  communicate  to  the  nerve  cen- 
tres this  necessity.  The  only  logical  place  at  which  such  an 
interference  with  the  afferent  impulses  could  occur  is  at 
the  intervertebral  foramina. 

It  is  not  meant  to  be  understood  that  a  subluxation  in 
any  region  of  the  vertebral  column  will  cause  a  rise  of  the 
body  temperature.  The  change  in  the  temperature,  whether 
it  be  higher  than  normal,  or  subnormal,  is  limited  to  the 
region  of  the  body  supplied  by  the  spinal  segment  which  is 
involved,  and  in  which  the  reflex  arc  is  interrupted.  Sub- 
luxations may,  however,  produce  a  rise  in  the  general  body 
temperature  by  lowering  the  resistance  of  a  certain  part  of 
the  body  and  thus  making  it  a  favorable  culture  medium  for 
the  multiplication  of  germs  and  the  elaboration  of  their  toxins. 
In  this  connection  it  must  be  borne  in  mind  that  in  any  in- 
fectious disease  it  is  not  the  germs  which  produce  the  fever, 
but  the  circulation  in  the  blood  of  their  toxins.  It  is  for  this 
reason,  that  in  typhoid  fever,  for  example,  the  fever  is  so 
rapidly  reduced  by  spinal  adjustment  of  the  segments  which 
control  the  intestines  and  spleen.  These  parts  form  the  point 
of  predilection  of  the  typhoid  bacilli,  and  when  their 
resistance  is  restored  to  a  normal  degree,  the  further  forma- 
tion of  toxins  by  the  bacilli  is  prevented,  and  the  fever 
subsides. 

Subluxations  in  the  upper  cervical  region  may  also  direct- 
ly influence  the  general  body  temperature,  by  disturbing  the 
excitability  of  the  reflex  heat  centre  in  the  medulla.  Thus 
fever  is  very  often  reduced  simply  by  an  adjustment  of  these 
vertebrae. 

Eflfect  of  Vertebral  Subluxations  on  Metabolism. — Some- 
thing has  already  been  said  of  the  effect  of  subluxation  of 
vertebrae  on  metabolism  in  connection  with  their  effect  on 
nutrition.  As  a  matter  of  fact,  the  effect  of  subluxations  on 
metabolism  is  so  closely  interwoven  with  all  the  other  dis- 


VERTEBRAL  SUBLUXATIONS  ON  NERVE  FUNCTION  209 

turbances  of  nerve  action  that  discussion  of  it  enters  into  all 
of  their  effects  on  other  functions  of  the  nerves. 

Subluxations,  especially  by  preventing  the  conduction  of 
the  impulses  from  the  sympathetic  nerves,  cause  a  disturb- 
ance in  metabolism.  When  the  metabolism  of  a  part  is  dis- 
turbed, its  functional  activity  necessarily  suffers.  Thus  when 
the  sympathetic  nerve-supply  to  a  gland  is  withdrawn,  by  a 
subluxation  in  the  segment  which  governs  it,  the  secretion 
from  this  gland  will  be  very  much  less  rich  in  its  essential 
constituents.  In  this  manner,  a  subluxation  in  the  segment 
controlling  the  liver  may  lead  to  numerous  disorders  as  a 
result  of  the  functional  inactivity  of  that  organ,  with  a  con- 
sequent diminished  flow  of  bile.  Also  a  subluxation  in  the 
segment  governing  the  pancreas  may  produce  a  total  cessa- 
tion of  its  secretory  activity,  and  lead  to  diabetes,  which  is 
generally  classed  among  the  diseases  of  metabolism.  In  like 
manner  all  the  many  diseases  of  metabolism  may  be  traced 
to  mal-alignment  of  certain  vertebrae. 

Effect  of  Vertebral  Subluxations  on  Circulation. — The 
connection  between  subluxations  and  the  circulation  of  the 
blood  is  exceedingly  close.  Physiological  experiments  show 
that  pressure  upon  the  sympathetic  nerves  sufficient  to  pre- 
vent the  conduction  of  their  efferent  impulses  will  produce 
vascular  congestion  of  the  parts  supplied  by  it.  This  is  ex- 
actly what  occurs  when,  as  a  result  of  a  subluxation,  the 
margins  of  the  intervertebral  foramina  press  upon  the  white 
rami  communicantes. 

As  an  example  of  the  results  of  the  effects  of  vertebral 
subluxations  on  the  circulation  the  following  may  be  cited : 
The  superior  cervical  ganglion  of  the  sympathetic  system 
governs  the  circulation  of  the  blood  to  the  cranium.  A  sub- 
luxation in  this  region  of  the  vertebral  column  will  therefore 
very  frequently  produce  cerebral  congestion.  In  like  man- 
ner congestion  in  any  part  of  the  body  is  induced  by  a  sub- 
luxation affecting  the  segment  controlling  such  a  part.  The 
disturbances  in  the  functional  activity  and  organic  integrity 
of  parts  so  affected  are  very  numerous,  and  all  respond  to 
correction  of  the  subluxation  by  spinal  adjustment. 

Effect  of  Vertebral  Subluxations  on  the  Organs.— Aside 
from  the  derangements  produced  in  the  organs  by  subluxa- 


210  SPINAL  ADJUSTMENT 

tions  influencing  their  functional  activity  indirectly,  they  are 
also  influenced  directly.  This  is  true  for  the  reason  that  the 
sympathetic  system  has  an  action  entirely  independent  of  the 
cerebro-spinal  system  in  those  organs  in  which  terminal 
ganglia  are  located. 

Thus  a  subluxation  of  any  of  the  upper  cervical  vertebrae 
will  directly  influence  the  action  of  the  heart.  This  is  ac- 
complished as  follows :  The  displaced  vertebra,  by  produc- 
ing pressure  upon  the  rami  to  the  cervical  gangha,  prevents 
the  condition  of  impulses  to  the  cardiac  ganglia  and  disturbed 
action  of  the  heart  follows.  Again  subluxations  in  the  mid- 
dorsal  region  cause  disturbances  of  the  stomach,  by  a  similar 
effect  upon  the  splanchnics. 

Effect  of  Vertebral  Subluxations  on  Reflex  Action. — Re- 
flex actions  which  are  performed  in  health  have  a  distinct 
purpose,  and  are  adapted  to  producing  some  end  which  is 
desirable  and  necessary  for  the  well-being  of  the  body.  All 
reflex  actions  are  motor,  and  depend  upon  the  unimpeded 
conductivity  of  the  nerves  involved  in  the  action.  Thus  pres- 
sure upon  the  afferent  and  efferent  nerves  consequent  upon  a 
vertebral  mal-alignment  prevents  the  conduction  of  the  im- 
pulses from  the  periphery  to  the  spinal  centre,  or  the  conduc- 
tion of  the  outgoing  impulses  from  the  spinal  centre  to  the 
part  for  which  they  are  destined. 

For  example,  it  is  through  the  afferent  impulses  excited  in 
the  wall  of  the  bowel  that  the  centre  in  the  spinal  cord  regu- 
lating the  movement  of  their  muscular  coat  sends  out  im- 
pulses producing  this  movement.  If,  however,  a  subluxation 
exists  in  the  lower  dorsal  or  upper  lumbar  region  of  the 
spinal  column,  the  reflex  arc  is  broken,  and  the  impulses 
which  are  reflexly  produced  as  a  result  of  the  stimulation 
in  the  wall  of  the  bowel,  never  reach  its  musculature.  As  a 
consequence  of  this  lack  of  muscular  action,  constipation 
results. 

Another  example  of  the  reflex  action  being  interrupted 
is  that  in  which  secretion  is  stopped  as  a  result  of  it.  Thus 
if  the  impulses  which  are  sent  to  the  stomach,  producing  the 
secretion  of  gastric  juice  when  food  enters  it,  are  prevented 
from  reaching  it,  as  a  result  of  a  subluxation,  indigestion 
will  follow. 


VERTEBRAL  SUBLUXATIONS  ON  NERVE  FUNCTION  211 

Effect  of  Vertebral  Subluxations  on  the  Cranial  Nerve 
Functions. — Subluxations  in  the  upper  cervical  region,  and  of 
any  of  the  upper  six  dorsal  vertebrae  will  affect  the  function 
of  the  cranial  nerves.  The  manner  in  w^hich  this  is  brought 
about  is  as  follows :  All  anatomists  are  agreed  that  the  gray 
rami  communicantes  of  the  superior  cervical  ganglion  of  the 
gangliated  cord  communicate  with  all  the  cranial  nerves. 
Some  of  the  fibres  of  the  gray  rami  pass  to  the  origin  of  the 
cranial  nerves  in  the  brain,  while  others  accompany  the  nerves 
throughout  their  distribution.  Since  the  superior  cervical 
ganglion  connects  with  the  first  four  spinal  nerves  through 
the  medium  of  both  gray  and  white  rami,  the  cranial  nerves 
communicate  directly  with  these  spinal  nerves.  Impulses, 
therefore,  which  pass  through  the  spinal  nerves,  through  the 
rami  communicantes,  to  the  cranial  nerves  may  thus  be  inter- 
rupted by  impingement  of  the  first  four  spinal  nerves.  Ref- 
erence to  the  chapter  dealing  with  the  connection  between 
the  sympathetic  system  and  the  cranial  nerves  will  give  the 
reader  an  exact  idea  of  how  vertebral  subluxations  may 
influence  individual  cranial  nerves  in   any  given  case. 

As  an  example  of  the  influence  of  subluxations  on  the 
action  of  the  cranial  nerves,  we  will  consider  the  disturbances 
of  the  third  cranial  nerve  as  a  result  of  a  break  in  the  con- 
tinuity of  the  reflex  arc.  As  is  well  known,  perfect  vision 
depends  partly  upon  the  power  of  accommodation,  as  regu- 
lated by  the  proper  contraction  and  dilatation  of  the  pupil. 
The  pupillary  reflex  is  governed  by  the  motor  oculi,  or  third 
cranial  nerve.  Having  reached  the  cilio-spinal  centres  in 
the  cord,  from  the  brain,  the  optic  impulses  take  one  of  two 
possible  courses :  They  leave  the  cord  through  the  anterior 
roots  of  the  upper  thoracic  nerves  and  run,  in  succession, 
through  the  rami  communicantes,  the  cervical  portion  of  the 
gangliated  cord  of  the  sympathetic,  the  cavernous  plexus, 
the  ciliary  ganglion  and  the  short  ciliary  nerves  to  the  radiat- 
ing fibres  of  the  iris,  producing  dilatation  of  the  pupil.  It  can 
be  readily  appreciated  what  would  happen  to  these  impulses 
were  the  power  of  conduction  of  the  upper  dorsal  spinal  nerves 
to  be  destroyed  by  pressure  upon  them  of  the  displaced 
margins  of  one  of  the  intervertebral  foramina  in  this  region. 
The  contraction  of  the  pupil  is  prevented  in  the  same  manner. 


212  SPINAL  ADJUSTMENT 

In  this  way,  by  tracing  the  nerve-supply  of  any  part  hav- 
ing connection  with  the  cranial  nerves,  the  effects  of  a  verte- 
bral subluxation  upon  the  function  of  that  nerve  may  be 
readily  determined. 


SECTION  FIVE 
Spinal  Analysis 


CHAPTER  I 

Segmentation  and  Localization 

The  first  requisite  to  a  scientific  application  of  spinal 
analysis  is  a  knowledge  of  the  vertebral  column  as  a  whole, 
and  of  the  various  groups  of  vertebrae  which  comprise  it,  to- 
gether with  their  ligaments.  The  next  essential  is  an  exact 
knowledge  of  the  segmentation  of  the  spine  and  of  the  point 
of  emergence  of  the  spinal  nerves. 

The  Vertebral  Column. — The  spine  is  a  flexible  and  flexu- 
ous  column  composed  of  a  series  of  bones,  called  vertebrae 
(from  vertere,  to  turn).  There  are  33  vertebrae,  divided  into 
five  groups,  and  named  according  to  the  region  which  they 
occupy,  as,  7  cervical  (in  the  neck),  12  thoracic  (at  the  level 
of  the  thorax),  5  lumbar  (at  the  level  of  the  abdomen),  5 
sacral  (at  the  level  of  the  pelvis),  and  4  coccygeal  (forming 
the  coccyx).  Those  of  the  upper  three  regions,  namely  the 
first  twenty-four  vertebrae,  are  separate  throughout  life,  and 
are  known  as  movable  or  true  vertebrae.  The  succeeding 
five,  or  sacral,  become  united  in  the  adult  to  form  the  sacrum, 
and  the  last  four,  or  coccygeal,  unite  to  form  the  tip  of  the 
spine,  or  coccyx;  these  lower  nine  vertebrae  are  accordingly 
called  fixed  or  false  vertebrae,  since  they  have  no  mobility 
and  are  not  individual  bones. 

Although  the  vertebrae  differ  markedly  in  some  respects, 
each  vertebra  is  constructed  on  a  common  plan,  which  is 
more  or  less  modified  in  diflferent  regions  to  meet  special 
requirements.  Thus  each  vertebra  consists  of  two  parts,  a 
solid  part,  or  body,  in  front,  and  a  circular  part,  or  arch, 
behind.     The  bodies  are  set  one  upon  the  other,  forming  a 

213 


214  SPINAL  ADJUSTMENT 

strong  pillar  to  support  the  head  and  trunk ;  the  arches  also 
set  one  upon  the  other  and  form  a  cylinder  which  contains 
the  spinal  cord.  Between  the  bodies  there  are  placed  cushion- 
like pads  of  cartilage  which  prevent  jarring  and  act  in  the 
same  capacity  that  the  cartilaginous  covering  of  the  articular 
ends  of  all  bones  do,  namely  prevent  friction  between  the 
bones  and  promote  the  greatest  freedom  of  movement.  Each 
arch  contains  a  notch  on  its  upper  and  lower  surface,  and 
when  these  are  united  with  the  corresponding  ones  above 
and  below,  circular  openings  are  formed  through  which  the 
spinal  nerves  pass  outward. 

The  body,  or  centrum,  is  a  solid  disc  of  bone,  about  three- 
fourths  of  an  inch  in  thickness  and  from  one  to  two  inches 
in  diameter.  It  is  convex  in  front,  and  concave  behind,  from 
side  to  side.  It  is  concave  from  above  downward  in  front, 
and  nearly  flat  behind.  Its  anterior  surface  is  perforated  by 
a  few  small  openings  for  the  entrance  of  nutrient  vessels ;  its 
posterior  surface  has  one  large  opening  for  the  exit  of  the 
vein. 

The  intervertebral  cartilaginous  discs  are  placed  between 
the  bodies  of  the  vertebrae,  whose  upper  and  lower  surfaces 
are  slightly  concave  and  rough  for  their  attachment. 

The  pedicles  are  two-  short,  thick  pieces  of  bone  which 
project  backward  from  the  upper  and  outer  corner  of  the 
posterior  aspect  of  the  body.  Upon  the  upper  and  lower 
surfaces  of  these  are  located  the  notches  whose  union  forms 
the  intervertebral  foramina. 

The  laminae  are  two  broad,  fiat,  sloping  plates,  joined  to 
the  pedicles  on  each  side,  and,  passing  backward,  are  joined 
to  each  other  behind.  They  complete  the  foramen  which  en- 
closes and  protects  the  spinal  cord,  and  which  is  termed 
the  spinal  foramen.  Their  borders  are  rough  for  the 
attachment  of  the  ligamenta  flava. 

The  spinous  process  projects  backward  from  the  junction 
of  the  two  laminae  and  serves  for  the  attachment  of  muscles 
and  ligaments.  Palpation  of  these  processes  is  used  to  de- 
termine from  their  relation  to  each  other  if  there  is  any 
displacement  of  the  vertebrae. 

The  transverse  processes,  two  in  number,  project  outward 
at  each  side  from  the  junction  of  the  pedicles  and  laminae. 


SEGMENTATION   AND   LOCALIZATION  215 

They  also  serve  for  the  attachment  of  muscles  and  Hgaments. 
These  processes  are  of  even  greater  importance  than  the 
spinous  process  in  determining  the  existence  of  a  subluxation 
and  its  character. 

The  articular  processes,  two  on  each  side,  namely  the 
superior  and  inferior,  project  upward  and  downward  from 
the  junction  of  the  laminae  and  pedicles.  Their  surfaces  are 
smooth,  and  when  the  vertebrae  are  joined,  they  articulate 
with  the  ones  above  and  below. 

Let  us  next  consider  the  special  characteristics  of  the 
vertebrae  of  each  region  of  the  spinal  column,  as  these  fac- 
tors have  an  important  bearing  on  the  possible  varieties  of 
subluxations  of  the  vertebrae  of  each  region. 

The  Cervical  Vertebrae. — The  body  of  these  vertebrae  is 
small,  and  broader  from  side  to  side  than  from  before  back- 
ward. The  anterior  and  posterior  surfaces  are  flattened  and 
of  equal  depth.  Its  upper  surface  is  concave  transversely, 
and  has  a  projecting  lip  on  each  side;  its  lower  surface  is  con- 
vex transversely,  and  has  a  shallow  groove  on  each  side  which 
receives  the  lip  of  the  vertebra  below.  The  pedicles  are  di- 
rected outward  and  backward,  and  spring  from  the  body 
about  midway  between  the  upper  and  lower  borders.  The 
superior  and  inferior  notches  are  nearly  equal  in  depth,  though 
the  inferior  are  generally  somewhat  deeper.  The  laminae  are 
long  and  narrow,  and  overlap  each  other  behind ;  they  enclose 
the  spinal  foramen  which  is  very  large  and  of  triangular  form. 
The  spinous  process  is  short,  and  its  extremity  bifid.  The 
articular  processes  are  situated  at  the  junction  of  the  laminae 
and  pedicles,  and  are  obliquely  placed,  and  their  surface  is 
flat.  The  superior  projects  backward  and  upward,  the  inferior 
forward  and  downward. 

The  Thoracic  Vertebrae. — The  body  of  these  vertebrae  is 
heart-shaped,  and  as  broad  from  before  backward  as  from 
side  to  side.  It  is  thicker  behind  than  in  front,  which  pro- 
duces the  curve  of  the  spinal  column  in  the  thoracic  region. 
The  upper  and  lower  surfaces  are  flat ;  it  is  convex  in  front,  and 
deeply  concave  behind.  On  each  side  of  the  body  where  it 
joins  the  arch  are  placed  two  semilunar  depressions ;  these 
unite  with  the  ones  above  and  below  to  form  complete  articu- 
lar facets  for  the  heads  of  the  ribs.     The  upper  and  lower 


216  SPINAL  ADJUSTMENT 

thoracic  vertebrae  somewhat  resemble  the  cervical  and  lum- 
bar vertebrae  respectively.  The  pedicles  are  directed  back- 
ward, and  the  intervertebral  notches  on  their  under  surface 
are  large  and  deeper  than  in  any  other  region  of  the  spine. 
The  laminae  are  broad  and  thick,  and  overlap  each  other.  The 
spinal  foramen  is  small  and  circular.  The  spinous  process  is 
long,  three-sided,  and  directed  obliquely  downward ;  they  over- 
lap each  other  especially  from  the  fifth  to  the  eighth.  The 
articular  processes  project  from  the  upper  and  lower  surfaces 
of  the  pedicles ;  their  surfaces  are  placed  nearly  vertical,  and 
are  flat ;  the  superior  is  directed  backward  and  upward,  the 
inferior,  forward  and  downward.  The  transverse  processes 
are  thick,  strong,  of  great  length,  and  directed  obliquely  back- 
ward and  outward ;  their  end  is  clubbed  and  tipped  with  a 
small  concave  surface  for  articulation  with  the  tubercle  of  a 
rib. 

The  Lumbar  Vertebrae. — The  body  of  these  vertebrae  is 
large,  kidney-shaped,  and  slightly  thicker  in  front  than  be- 
hind, which  forms  the  lumbar  curve  of  the  spine.  The  pedicles 
are  very  strong,  and  extend  directly  backward  from  the  upper 
part  of  the  body,  which  makes  the  intervertebral  notches  very 
deep.  The  laminae  are  broad,  short,  and  strong.  The  spinal 
foramen  is  triangular ;  it  is  larger  than  in  the  thoracic,  and 
smaller  than  in  the  cervical  region.  The  spinous  processes 
are  thick,  broad,  quadrilateral,  and  horizontal  in  direction ; 
they  are  thicker  below  than  above,  and  end  in  a  rough,  un- 
even border.  The  articular  processes  are  thick  and  strong; 
the  superior  are  concave,  and  look  backward  and  inward ;  the 
inferior  are  convex,  and  look  forward  and  outward.  The 
transverse  processes  are  long,  slender,  and  spatula-shaped ; 
they  are  directed  transversely  outward  in  the  upper  three 
lumbar  vertebrae,  and  slant  a  little  upward  in  the  lower  two. 

The  Normal  Curves  of  the  Spine. — As  a  further  assistant 
to  the  making  of  a  correct  spinal  analysis  a  knowledge  of  the 
curves  of  the  spine  is  very  useful. 

When  the  spine  is  viewed  from  the  side,  it  will  be  noted 
that  there  are  four  curves ;  that  in  the  cervical  region,  in 
which  the  convexity  is  anteriorly  directed ;  that  in  the  thoracic 
region,  in  which  the  convexity  is  posteriorly  directed ;  that  in 
the  lumbar  region,  in  which  the  convexity  is  again  directed 


SEGMENTATION   AND   LOCALIZATION  217 

anteriorly ;  lastly,  the  sacral  curve  the  convexity  of  which  is 
directed  backward. 

The  curves  vary  in  different  individuals,  and  also  accord- 
ing to  age,  sex,  occupation,  etc.  A  difference  in  the  curves  is 
also  noted  at  different  times  of  the  day,  owing  to  the  com- 
pression of  the  discs  due  to  the  upright  posture.  It  is  very 
important  to  determine  any  abnormality  of  these  curves,  from 
the  standpoint  of  spinal  adjustment,  and  this  will  be  consid- 
ered in  detail  further  on. 

The  twenty-three  intervertebral  discs  between  the  bodies 
of  the  vertebrae  tend  to  give  the  spine  as  a  whole  its  great 
flexibility;  the  muscles  and  ligaments  attached  to  its  sur- 
faces and  processes  also  assist  in  this,  and  are  important  fac- 
tors in  maintaining  its  normal  poise  and  preventing  subluxa- 
tions. By  viewing  the  spinal  column  anteriorly,  it  will  be 
noted  that  the  extremities  of  the  transverse  processes  of  the 
atlas  extend  laterally  to  about  the  same  distance  as  those  of 
the  first  thoracic  vertebra.  The  transverse  processes  of  the 
other  cervical  vertebrae  are  rudimentary,  and  increase  in 
length  in  proportion  to  the  increase  in  the  width  of  the  bodies, 
until  the  first  thoracic  vertebra  is  reached.  The  transverse 
processes  gradually  decrease  in  length  from  this  point  to  the 
twelfth  thoracic  vertebra.  In  the  lumbar  region,  the  trans- 
verse processes  of  the  first  lumbar  vertebra  extend  laterally 
further  than  those  of  the  first  thoracic ;  those  of  the  second 
lumbar  are  longer  than  those  of  the  first ;  those  of  the  third 
are  longer  than  those  of  the  second.  From  this  point  diminu- 
tion in  length  again  is  noted,  the  fourth  corresponding  to  the 
first,  and  the  fifth  to  the  second  lumbar  vertebra. 

Movements  of  the  Spine. — It  will  be  noted,  in  considering 
the  movements  of  the  spine,  that  in  the  adult  a  little  more  than 
one-fifth  of  this  movement  occurs  in  the  neck,  and  that  a  little 
less  than  one-third  of  this  movement  occurs  in  the  lumbar 
region.  Various  peculiarities  of  the  vertebrae  in  the  different 
regions  of  the  spinal  column  modify  the  degree  of  motion  of 
the  spine  as  a  whole.  Thus  the  differences  in  the  thickness 
of  the  discs,  the  vertical  measurements  of  the  bodies,  and  the 
fact  that  the  bodies  are  not  perfectly  circular  modify  the  move- 
ments of  the  spine  in  certain  regions.  The  shape  and  place- 
ment of  the  articular  processes  also  influence  the  degree  of 


218  SPINAL  ADJUSTMENT 

certain  movements  in  various  regions  of  the  spine.  In  the 
dorsal  region,  the  attachment  of  the  ribs  to  the  bodies  of  the 
vertebrae  also  makes  some  movements  more  restricted  than 
in  other  regions.  The  ligaments  of  the  spine  also  have  a 
tendency,  when  perfect  balance  exists  on  both  sides,  to  limit 
the  degree  of  movement  of  the  spine,  when  excessive,  by  the 
tension  which  is  produced  in  the  ligaments  on  the  side  of  the 
bodies  opposite  to  the  direction  of  the  motion.  The  resistance 
to  compression  of  that  side  of  the  intervertebral  disc  toward 
which  the  motion  occurs  also  tends  to  limit  any  excessive 
movement  of  the  vertebrae. 

The  amount  of  all  movements  of  the  spine  varies  in  dif- 
ferent individuals,  and  as  age  advances  there  is  a  progressive 
decrease  in  the  limits  of  mobility  of  the  vertebral  column. 
This  is  simply  due  to  the  varying  degrees  of  elasticity  of  the 
parts  involved. 

The  movements  of  which  the  spine  is  capable  are : 

1.  Flexion. 

2.  Extension. 

3.  Rotation. 

4.  Lateral  motion. 

5.  Mixed  motion. 

Flexion,  or  forward  bending,  is  more  free  in  the  cervical 
region  than  extension,  which  is  limited  by  the  locking  of  the 
laminae  when  the  head  is  thrown  back  as  far  as  possible.  In 
the  lower  thoracic  and  lumbar  regions  flexion  is  comparatively 
free.  Before  the  consolidation  of  the  spine,  flexion  of  a  slight 
degree  is  possible  throughout  the  vertebral  column. 

,  Extension  in  the  neck  is  limited  by  the  locking  of  the 
laminae.  In  the  other  regions  of  the  spine  it  is  speedily 
checked  by  the  locking  of  the  laminae  and  spinous  processes;, 
this  movement  is  chiefly  limited  to  the  last  two  thoracic  and 
the  lumbar  vertebrae. 

Lateral  movement  is  greatest  in  the  cervical  region,  fol- 
lowed by  that  of  the  thoracic  and  lumbar  regions. 

Rotation  is  freest  in  the  cervical  region,  considerable  in 
the  thoraic  region,  and  least  in  the  lumbar  region. 

Mixed  movements  are  combinations  of  any  of  the  above 
movements.  Thus  lateral  movement  is  nearly  always  associ- 
ated with  rotation. 


SEGMENTATION    AND    LOCALIZATION  219 

Position  of  the  Vertebrae. — As  a  further  means  of  assis- 
tance in  the  making  of  a  correct  spinal  analysis  the  location 
of  the  various  vertebrae  is  very  essential.  The  following  are 
the  surface  landmarks  of  the  different  vertebrae : 

1st  Cervical:  This  vertebra  has  no  spinous  process,  and 
the  posterior  arch  is  between  the  occiput  and  the  spine  of  the 
axis.  The  transverse  processes  are  just  below  and  in  front  of 
the  tips  of  the  mastoid  processes. 

2nd  Cervical :  This  vertebra  is  most  easily  recognized  as 
being  the  first  spinous  process  below  the  occiput. 

3rd  Cervical :  The  spinous  process  of  this  vertebra  is 
very  difficult  to  palpate,  since  it  lies  beneath  the  overlapping 
spinous  process  of  the  axis,  and  can  only  be  felt  when  the 
neck  is  flexed.     It  is  the  second  below  the  occiput. 

4th  Cervical :  The  spinous  process  of  this  vertebra  is  the 
third  one  palpated  when  the  neck  is  flexed.  This  vertebra  is 
opposite  the  hyoid  bone. 

5th  Cervical :  This  vertebra  is  recognized  as  being  the 
fourth  palpated  when  the  neck  is  flexed. 

6th  Cervical :  This  vertebra  is  on  a  line  with  the  cricoid 
cartilage.  Its  spinous  process  is  directly  above  that  of  the 
vertebra  prominens. 

7th  Cervical :  This  vertebra  is  easily  recognized  by  the 
great  length  of  its  spinous  process,  which  is  used  as  a  land- 
mark in  counting  the  spinous  processes  upward  and  down- 
ward. 

1st  Thoracic :  The  spinous  process  of  this  vertebra  is  on 
a  line  with  the  superior  portion  of  the  spine  of  the  scapula, 
and  is  detected  by  placing  the  thumbs  on  the  spinous  process 
which  is  on  a  line  with  the  fingers  placed  on  the  superior 
surface  of  the  spines  of  the  scapulae. 

2nd  Thoracic :  The  spinous  process  of  this  vertebra  corre- 
sponds to  head  of  the  third  rib.  It  is  located  by  noting  it  as 
being  the  first  one  below  the  first  thoracic. 

3rd  Thoracic :  The  spinous  process  of  this  vertebra  is  on 
a  line  with  the  inner  edge  of  the  spine  of  the  scapula.  It  is 
the  second  spinous  process  below  the  first  thoracic. 

4th  Thoracic :  The  spinous  process  of  this  vertebra  is 
opposite  the  junction   of  the  first  and   second   parts  of  the 


220  SPINAL  ADJUSTMENT 

sternum.     It  is  located  by  counting  downward  from  the  first 
thoracic,  or  upward  from  the  seventh  thoracic  spine. 

5th  Thoracic :  The  spinous  process  of  this  vertebra  is 
most  easily  determined  by  counting  upward  from  the  seventh. 

6th  Thoracic :  The  spinous  process  of  this  vertebra  is 
directly  above  that  of  the  seventh. 

7th  Thoracic :  The  spinous  process  of  this  vertebra  cor- 
responds to  the  inferior  angle  of  the  scapula  when  the  sub- 
ject is  sitting  with  the  arms  hanging  at  the  sides,  and  half  an 
inch  above  when  the  subject  is  lying  prone.  It  is  located  by 
placing  the  thumb  on  a  line  with  the  finger  placed  on  the 
inferior  angle  of  the  scapula. 

8th  Thoracic :  The  spinous  process  of  this  vertebra  is 
most  readily  located  by  determining  the  position  of  the 
seventh  and  then  palpating  the  one  below  it. 

9th  Thoracic :  The  spinous  process  of  this  vertebra  is  also 
most  easily  determined  by  first  noting  the  position  of  the 
seventh,  and  then  counting  downward  from  this  point. 

10th  Thoracic :  The  spinous  process  of  this  vertebra  cor- 
responds to  the  level  of  the  ensiform  cartilage  of  the  sternum. 
It  is  located  about  half  an  inch  below  the  attachment  of  the 
tenth  rib,  which  is  followed  from  its  prominence  to  the  spine. 

lltli  Thoracic:  The  spinous  process  of  this  vertebra  is 
best  located  by  first  determining  the  position  of  the  tenth 
thoracic  vertebra. 

12th  Thoracic :  The  spinous  process  of  this  vertebra  cor- 
responds to  the  head  of  the  last  rib.  It  is  located  either  by 
counting  downward  from  the  seventh  or  the  tenth  thoracic 
spinous  process. 

1st  Lumbar:  The  spinous  process  of  this  vertebra  is 
most  easily  recognized  by  an  upward  count  from  the  fourth 
lumbar  spinous  process. 

2nd  Lumbar :  The  spinous  process  of  this  vertebra  is 
also  most  readily  located  by  counting  upward  from  the  spine 
of  the  fourth  lumbar. 

3rd  Lumbar:  The  spinous  process  of  this  vertebra  like  the 
first  and  second  is  determined  by  counting  upward  from  the 
fourth,  being  directly  above  that  vertebra. 

4th  Lumbar:  The  spinous  process  of  this  vertebra  is 
situated  at  the  level  of  a  line  drawn  between  the  iliac  crests. 


SEGMENTATION   AND   LOCALIZATION  221 

It  is  located  by  palpating  the  sacrum  and  fifth  lumbar  which 
are  immediately  below  it,  or  by  placing-  the  thumbs  midway 
between  the  fingers  placed  upon  the  crests  of  the  ilia  on  both 
sides. 

5th  Lumbar:  The  spinous  process  of  this  vertebra  is  lo- 
cated below  that  of  the  fourth  lumbar  vertebra  and  above  the 
sacrum. 

Tabulated  Attachment  of  Spinal  Nerves  to  Cord. — The 
following  table  by  Reid  gives  the  topography  of  the  attach- 
ment of  the  spinal  nerves  to  the  cord :  A  marking  the  highest 
and  B  the  lowest  level.  A  thorough  study  of  this  table  will 
aid  the  reader  in  segment  localization. 

NERVES : 

1st  Cervical  connects  opposite  superior  margin  of  Foramen 
Magnum  and  just  below  the  inferior  margin. 

2nd  Cervical:     (A)  A  little  above  posterior  arch  of  atlas. 

2nd  Cervical :  (B)  Midway  between  the  posterior  arch  of 
atlas  and  spine  of  axis. 

3rd  Cervical :     (A)  A  little  below  posterior  arch  of  atlas. 

3rd  Cervical:  (B)  Junction  of  upper  two-thirds  and  lower 
third  of  spine  of  axis. 

4th  Cervical :  (A)  Just  below  upper  border  of  spine  of 
axis. 

4th  Cervical:  (B)  Middle  of  spine  of  third  cervical  ver- 
tebra. 

5th  Cervical :  (A)  Just  below  the  lower  border  of  spine 
of  axis. 

5th  Cervical:  (B)  Just  below  lower  border  of  spine  of 
fourth  cervical. 

6th  Cervical :  (A)  Lower  border  of  spine  of  third  cer- 
vical vertebra. 

6th  Cervical:  (B)  Lower  border  of  spine  of  fifth  cervical 
vertebra. 

7th  Cervical :  (A)  Just  below  upper  border  of  spine  of 
fourth  cervical  vertebra. 

7th  Cervical:  (B)  Just  above  lower  border  of  spine  of 
sixth  cervical  vertebra. 

8th  Cervical :  (A)  Upper  border  of  spine  of  fifth  cervical 
vertebra. 


222  •     SPINAL  ADJUSTMENT 

8th  Cervical :  (B)  Upper  border  of  spine  of  seventh  cer- 
vical vertebra. 

1st  Thoracic:  (A)  Midway  between  spines  of  fifth  cer- 
vical and  sixth  cervical  vertebrae. 

1st  Thoracic:  (B)  Junction  of  upper  two-thirds  and  lower 
third  of  interval  between  seventh  cervical  and  first  thoracic. 

2nd  Thoracic :  (A)  Lower  border  of  spine  of  sixth  cer- 
vical vertebra. 

2nd  Thoracic :  (B)  Just  above  lower  border  of  spine  of 
first  thoracic. 

3rd  Thoracic :  (A)  Just  above  middle  of  spine  of  seventh 
cervical  vertebra. 

3rd  Thoracic:  (B)  Lower  border  of  spine  of  second 
thoracic  vertebra. 

4th  Thoracic :  (A)  Just  below  upper  border  of  spine  of 
first  thoracic. 

4th  Thoracic:  (B)  Junction  of  upper  third  and  lower 
two-thirds  of  spine  of  third  thoracic  vertebra. 

5th  Thoracic :  (A)  Upper  border  of  spine  of  second 
thoracic  vertebra. 

5th  Thoracic :  (B)  Junction  of  upper  quarter  and  lower 
three-quarters  of  spine  of  fourth  thoracic  vertebra. 

6th  Thoracic :  (A)  Lower  border  of  spine  of  second 
thoracic  vertebra. 

6th  Thoracic :  (B)  Just  below  upper  border  of  spine  of 
fifth  thoracic. 

7th  Thoracic :  (A)  Junction  of  upper  third  and  lower 
two-thirds  of  spine  of  fourth  thoracic  vertebra. 

7th  Thoracic :  (B)  Just  above  lower  border  of  fifth 
thoracic. 

8th  Thoracic :  (A)  Junction  of  upper  two-thirds  and 
lower  third  of  interval  between  spines  of  fourth  thoracic  and 
fifth  thoracic  vertebrae. 

8th  Thoracic :  (B)  Junction  of  upper  quarter  and  lower 
three-quarters  of  spine  of  sixth  thoracic  vertebra. 

9th  Thoracic :  (A)  Midway  between  spines  of  fifth  tho- 
racic and  sixth  thoracic  vertebrae. 

9th  Thoracic:  (B)  Upper  border  of  spine  of  seventh 
thoracic  vertebra. 


SEGMENTATION. AND   LOCALIZATION  223 

10th  Thoracic :  (A)  Midway  between  spines  of  sixth  and 
seventh  thoracic  vertebra. 

10th  Thoracic:  (B)  Middle  of  spine  of  eighth  thoracic 
vertebra. 

11th  Thoracic:  (A)  Junction  of  upper  quarter  and  lower 
three-quarters  of  spine  of  seventh  thoracic. 

12th  Thoracic:  (B)  Just  below  spine  of  ninth  thoracic 
vertebra. 

1st  Lumbar:  (A)  Midway  between  spines  of  eighth 
thoracic  and  ninth  thoracic  vertebra. 

1st  Lumbar:  (B)  Lower  border  of  spine  of  tenth  tho- 
racic vertebra. 

2nd  Lumbar:  (A)  Middle  of  spine  of  ninth  thoracic 
vertebra. 

2nd  Lumbar:  (B)  Junction  of  upper  third  and  lower 
two-thirds  of  spine  of  eleventh  thoracic  vertebra. 

3rd  Lumbar :  (A)  Middle  of  spine  of  tenth  thoracic  ver- 
tebra. 

3rd  Lumbar:     (B)  Just  below  spine  of  eleventh  thoracic. 

4th  Lumbar :  (A)  Just  below  spine  of  tenth  thoracic 
vertebra. 

4th  Lumbar:  (B)  Junction  of  upper  quarter  and  lower 
three-quarters  of  spine  of  twelfth  thoracic  vertebra. 

5th  Lumbar:  (A)  Junction  of  upper  third  and  lower 
two-thirds  of  spine  of  eleventh  thoracic  vertebra. 

5th  Lumbar  :  (B)  Middle  of  spine  of  twelfth  thoracic  ver- 
tebra. 

1st  Sacral  to  5th  Sacral:  (A)  Just  above  lower  border  of 
spine  of  eleventh  thoracic  vertebra. 

1st  Sacral  to  5th  Sacral:  (B)  Lower  border  of  spine  of 
first  lumbar  vertebra. 

Coccygeal :  (A)  Lower  border  of  spine  of  first  lumbar 
vertebra. 

Coccygeal :  (B)  Just  below  upper  border  of  spine  of 
second  lumbar  vertebra. 

The  Exit  of  the  Spinal  Nerves  in  Respect  to  the  Spinous 
Processes. — The  following  table  gives  the  surface  markings 
of  the  emergence  of  the  spinal  nerves  from  the  intervertebral 
foramina,  in  respect  to  the  spinous  processes ;  the  roots  of  the 
spinal  nerves   from   their  origin   in   the  cord   run   obliquely 


224  SPINAL  ADJUSTMENT 

downward  to  their  point  of  exit  from  the  intervertebral 
foramina,  the  amount  of  obliquity  varying  in  different  regions 
of  the  spine,  and  being  greater  in  the  lower  than  upper  part. 
Thus  the  level  of  their  emergence  from  the  intervertebral 
foramina  does  not  correspond  to  the  point  of  emergence  of 
the  nerve  from  the  cord.  For  example,  the  ninth  thoracic 
nerve  emerges  from  the  cord  at  the  level  of  the  seventh 
thoracic  spinous  process,  while  the  level  of  its  emergence 
from  the  intervertebral  foramen  is  at  the  eighth  thoracic 
spinous  process.  In  the  preceding  table  the  relation  between 
the  emergence  from  the  cord  and  the  spinous  processes  was 
given ;  in  the  following  table  the  relation  of  the  exit  of  the 
spinal  nerves  from  the  intervertebral  foramina  to  the  spinous 
processes  will  be  shown. 

Spinal  Nerve  Level  of  Emergence 

C  I  Between  occiput  and  spine  of  axis. 

C  II  Middle  of  spine  of  axis. 

C  III  End  of  spine  of  axis. 

C  IV  Spine  of  third  cervical  vertebra. 

C  V  Spine  of  fourth  cervical  vertebra. 

C  VI  Spine  of  fifth  cervical  vertebra. 

C  VII        Spine  of  sixth  cervical  vertebra. 
C  VIII      Spine  of  vertebra  prominens. 
D  I  Between  seventh  cervical  and  first  dorsal  spines. 

D  II  Between  spines  of  first  and  second  dorsal  verte- 

brae. 
D  III         Between  spines  of  second  and  third  dorsal  verte- 
brae. 

Spine  of  third  dorsal  vertebra. 

Spine  of  fourth  dorsal  vertebra. 

Spine  of  fifth  dorsal  vertebra. 

Between  spines  of  fifth  and  sixth  dorsal  vertebrae. 

Between  spines  of  sixth  and  seventh  dorsal  ver- 
tebrae. 

Spine  of  seventh  dorsal  vertebra. 

Spine  of  eighth  dorsal  vertebra. 

Between  spines  of  ninth  and  tenth  dorsal  ver- 
tebrae. 
D  XII        Spine  of  eleventh  dorsal  vertebra. 


DIV 

DV 

DVI 

DVII 

DVIII 

DIX 

DX 

DXI 

SEGMENTATION    AND    LOCALIZATION  225 

Spinal  Nerve  Level  of  Emergence 

L  I  Spine  of  twelfth  dorsal  vertebra. 

L  II  Between  spines  uf  first  and  second  lumbar  verte- 

brae. 
L  III  Spine  of  third  lumbar  vertebra. 

L  rV  Spine  of  fourth  lumbar  vertebra. 

L  V  Spine  of  fifth  lumbar  vertebra. 

Segmental  Localization. — "A  spinal  segment  is  that  part  of 
the  cord  contained  between  two  sets  of  roots.  Each  segment 
must  be  regarded  as  a  unit  endowed  with  motor,  sensory, 
trophic,  vasomotor,  and  reflex  functions  in  respect  to  the  parts 
supplied  by  the  roots  of  the  nerves  which  emerge  from  and 
enter  it.  A  segment  is  named  from  the  nerve-roots  which 
take  their  origin  from  it,  and  not  from  the  vertebra  with 
which  it  corresponds."  (Abrams.) 

The  following  table,  by  Sherrington,  slightly  modified, 
shows  the  different  segments  and  the  various  parts  which 
they  control.  This  table  is  compiled  from  data  collected  from 
sources  both  clinical  and  experimental ;  the  latter  are  dis- 
tinguished by  being  printed  in  italics,  and  rest  on  observations 
obtained  chiefly  from  the  dog  and  monkey. 


226 


SPINAL  ADJUSTMENT 


AFFERENT  ROOT. 


No.  of 

Nerve. 


Skin. 


Muscle. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


Ci. 


No  afferent  root 
usually  present. 


Just 
above  arch 
of  atlas. 


C  II.  Side  of  head  from  mid- 

line of  scalp  to  mid-line 
under  mouth  behind  chin. 
Ant.  border  lies  about 
midway  between  root  of 
pinna  and  outer  angle 
of  orbit,  and  about 
midway  between  hind 
edge  of  ascend,  ramus  of 
lower  jaw  and  angle  of 
mouth.  Post,  border 
from  belotv  external  oc- 
ripit.  protiib.  runs  well 
behind  pinna,  to  the  cri- 
coid cartilage. 


Same 
as 


Same 

as 
motor. 


Drawing  up  of 
shoulder,  down  of 
head  to  same  side  ; 
turning  of  chin 
toward  oppos. 
shoulder  with  the 
neck. 


Ranges 
from  just 
a  b  o  V  e  to 
just  be- 
low spine 
of  atlas. 


C  III.  From    mid-scalp   little 

behind  halfway  between 
top  of  occiput  and  ext. 
occipt.  protub.  the  ant. 
border  runs  behind  pinna 
and  post,  edge  of  low. 
jaw  to  reach  the  thyroid 
cartilage.  The  post,  bor- 
der passes  from  the  mid- 
dorsal  line  of  neck  below 
level  of  fourth  cervical 
spine  and  slopes  to  root 
of  acromion,  turns  and 
forms  a  characteristic 
notch,  then  crosses  chest 
below  clavicle  to  reach 
sternum  at  second  costal 
cartilage. 


Same 


E  I  e  V  a  tion  of  At  or  a 

shoulder,  drawing  little 

down  of  h  e  a  d  to  above    the 

same  side;  flexion  spine  of 

of  elbow  feeble  the  axis. 
and  occasional. 


C  IV.  Ant.  edge  runs  from 

just  above  exter.  occipit. 
pro  tuberance  outward 
close  behind  root  of 
pinna  and  well  behind 
angle  of  jaiv  to  reach  be- 
low cricoid.  Post,  edge 
runs  from  mid-line  of 
back  on  level  tcith  top  of 
scapula,  slopes  over  root 
of  scapular  spine,  crosses 
infra-spinous  fossa  to 
leave  mid-ioay  between 
acromion  and  inferior 
angle,  winds  halfway 
down  upper  arm,  turns 
upon  coracobrachialis 
over  pectoral  fold  to  pass 
ivell  above  the  nipple  to 
third  cost.  cart. 


Same 

as 
motor. 


Retraction  o  f 
shoulder,  some- 
times lifting  of 
shoulder  ic4th  pro- 
traction; flexion 
at  elbow,  but  not 
invariably ;  lat- 
eral flexion  of 
neck;  occasion- 
ally flexion  ad- 
duction of  thumb. 


Ranges 
from  spine 
of  axis  to 
spine  of 
third  cer- 
vical ver- 
tebra. 


SEGMENTATION  AND  LOCALIZATION 


227 


EFFERENT  ROOT. 


Striped  Muscle. 


Chief  Movement 
Effected. 


Blood- 
Vessels. 


<j!Iands  of 
Viscera. 


Rectus  cap,  post.  maj. 
et.  min.  Obliq.  cap.  sup.  et 
inf.,  Trapezius,  S  t  e  r  n  o- 
mastoid.  Sternohyoid, 
Sternothyroid,  Omohyoid 
(esp.  ant.  belly),  Rectus 
later..  Rectus  cap.  ant. 
min..  Geniohyoid,  Thyro- 
hyoid ( ?Complexus). 


Lateral  flexion 
of  head  and  neck 
toirard  the  side 
stimulated,  with- 
out rotation  of 
the  head. 


Through 
c  o  n  n  e  c  tion 
with  sympa- 
t  h  e  t  i  c  sup- 
plies vis  cera 
as  s  h  o  w  n  in 
chapter  on 
Innervation. 


Through 
c  o  n  n  e  c  tion 
with  sympa- 
t  h  e  t  i  c  sup- 
plies vis  cera 
as  s  h  o  w  n  in 
chapter  on 
Innervation. 


Rectus  cap.  ant.  maj., 
Longus  colli,  Sternomas- 
toid,  Geniohyoid,  Sterno- 
hyoid, Sternothyroid,  Thy- 
rohyoid, Omohyoid  (espec 
post,  belly),  Cervicalls  as- 
cendens,  Trapezius,  Com- 
plexus,  O  b  I  i  q  u  u  s  inf., 
Trachelomastoid. 


Lateral  flexion 
of  the  neck  to  the 
side  stimulated, 
irith  some  retrac- 
tion; little  or  no 
rotation  of  the 
head,  but  the  chin 
may  be  turned 
slightly  t  o  ward 
oposite  side. 


Rectus  cap.  ant.  maj., 
Longus  colli,  Levat.  ang. 
scap..  Omohyoid  (post, 
belly).  Sternohyoid  (low- 
er part),  Complexus,  Sple- 
n  1  u  s,  Trachelomastoid, 
Trapezius,  Cervicalls  as- 
cendens,  Transversi  spi- 
n  a  1  e  s  (  ?Sternomastoid, 
Diaphragm). 


Lateral  flexion 
of  the  neck  to- 
irard the  side 
stimulated,  with 
marked  retrac- 
tion and  a  little 
turning  of  the 
neck,  so  that  chin 
is  thrust  up  to 
opposite  side. 


Levator  scapulae,  Longus 
colli.  Scalenus  med..  Tra- 
pezius Subclavius,  D  i  a- 
phragm  (front  or  sternal 
portion),  Complexus,  Sple- 
n  i  u  s,  Trachelomastoid, 
Cervicalls  ascendens, 
Transversospinales  (  ?Sca- 
lenus  anticus). 


E  I  e  V  a  tion  of 
.fhoulder,  dr a g- 
ging  it  headward 
and  toward  spinal 
column;  slight 
lateral  flexion  to- 
ward side  stimu- 
lated tc-ith  marked 
retraction.  With 
shoulder  fixed  the 
turning  of  the 
head  toward  op- 
p  0  sit  e  side  is 
more  marked. 


228 


SPINAL  ADJUSTMENT 


AB^FERENT  ROOT. 


No.  of 
Nerve. 


Skin. 


Musc'lo. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


C  V.  Ant.  border,  from  near      Same 

spine  of  third  cerv.  vert.,  as 
passes  down  to  outer  motor. 
third  of  clavicle  and 
along  it,  runs  inward  to 
mid-line  of  chest.  Post, 
border,  from  below  spine 
of  seventh  cerv.  vert., 
s  IV  e  e  p  s  outioard  over 
base  of  spine  of  scapula, 
enters  arm  beloxo  and  be- 
hind deltoid,  gets  on  to 
supinator  longus  and  re- 
curves on  that  nearly 
halfway  down  forearm; 
c7-osses  the  chest  two 
fingers'  breadths  above 
nipple  on  the  third  cost. 
eart. 

C  VI.  A  long  field  occupying       Same 

the  outer  and  radial  as-  as 

pect  of  the  arm  from  motor. 
just  below  the  deltoid 
insertion  above  to  the 
thumb  below,  and  no- 
where reaching  the  chest 
or  t  r  u  n  k.  /Sometimes 
more  or  less  of  the  index 
finger  is  included;  some- 
times, however,  the  field 
does  not  come  down  to 
as  far  as  the  styloid 
process  of  the  radius. 


Same 


Flexion  a  t  eU 
b  o  w ;  movement 
at  shoulder,  some- 
times retraction, 
sometimes  eleva- 
t  i  o  n;  adduction 
and  flexion  o  f 
thumb;  occasion- 
ally simple  adduc- 
tion at  shoulder. 


Flexion  at  el- 
bow;  adduction 
and  flexion  o  f 
thumb;  flexion  of 
other  digits;  re- 
traction of  shoul- 
der. 


Ranges 
from  low- 
er edge  of 
spine  of 
axis  to 
that  of 
fourth 
cerv.  ver- 
tebra. 


Ranges 
from  low- 
er edge  of 
spine  of 
third  to 
that  of 
fifth  cer- 
vical ver- 
tebra. 


CVII.  The  outer  (radial)  side 

of  lowest  third  of  upper 
and  of  ichole  of  forearm, 
and  hand  including  all 
the  fingers  except  the 
minimus  and  ulnar  side 
of  ring  finger. 


Same 

as 

motor. 

Triceps 

tap. 


Adduction  and 
flexion  of  thumb, 
and  flexion  o  f 
other  d  i  g  -Rt  s; 
flexion  at  elbow; 
retraction  at 
shoulder.  Perios- 
teal reflex  of  ra- 
dius and  ulna 
(Starr,  G  o  1  d- 
scheider.) 


Ranges 
b  e  t  w  een 
top  of 
fourth  and 
bottom  o  f 
sixth  spi- 
nous proc- 
ess. 


SEGMENTATION  AND  LOCALIZATION 


229 


EFFERENT   ROOT. 


Striped  Muscle. 


Chief  Movement 
Efifected. 


Blood- 
vessels. 


Glands  of 
Viscera. 


Levator  ang.  soap., 
Longus  colli,  Erector 
spinse,  Transversospinales, 
Rhomboid,  Subclavius, 
Diaphragm,  Serratus  mag- 
nus,  Scalen.  med.,  Deltoi- 
deus,  Teres  minor.  Sub- 
scapularis,  Supraspinatus, 
Infraspinatus,  Pectoralis 
maj.  (clavicular  portion), 
Biceps,  Brachialis  ant., 
Coracobrach.,  Ext.  carpi 
rad.  long.,  Supinator 
longus,  in  Macacus. 


Elevation,  ab- 
duction, and  some 
outward  rotation 
of  8  h  0  u  I  d  e  r; 
flexion  at  elbow, 
wrist  being  slight- 
ly s  u  p  i  n  a  t  ed  ; 
slight  radial  ab- 
duction at  wrist; 
slight  lateral 
flexion  of  n  e  c  k, 
with  some  retrac- 
tion of  head  to- 
ward side  stimu- 
lated. 


Through 
c  o  n  n  e  c  tion 
with  sympa- 
t  h  e  ti  c  sup- 
plies vis  cera 
as  shown  in 
chapter  on 
Innervation. 


Through 
c  o  n  n  e  c  tion 
with  sj'mpa- 
t  h  e  t  i  c  sup- 
plies V  i  s  cera 
as  s  h  o  w  n  in 
chapter  on 
Innervation. 


Longus  colli,  Erector 
spinas,  Transversospinales, 
R  h  0  m  boids.  Diaphragm, 
Subclavius,  Serratus  mag- 
nus,  Scaleni,  Deltoid, 
Teres  minor.  Teres  major, 
Subscapularis.  Supraspi- 
natus, Infraspinatus  Pec- 
toralis major  (clavicular 
head),  Latissimus  dorsi, 
Biceps,  Brachial-anticus, 
Coracobrachialis,  Triceps 
(outer  and  long  head), 
Ext.  carpi  rad.  long,  et 
brevior.  Pronator  teres. 
Supinator  long,  et  brevis.. 
Flexor  carpi  radialis. 
Flexor  carpi  ulnaris 
(feeble),  Extensor  com- 
munis digitorum,  in  Maca- 
cus. 


Moderate  ad- 
duction of  shoul- 
der;  at  e  I  b  0  10 
strong  flexion  ; 
some  supination 
of  w  r  i  s  t,  slight 
extension  of  wrist 
in  most  indi- 
viduals, but  in 
others  flexion  at 
wrist;  slight  ex- 
tension of  d/igits 
in  most  indi- 
viduals;  slight 
lateral  flexion  of 
head  to  side  stim- 
ulated, id  th  slight 
retraction  of 
head. 


Longus  colli,  Erector 
spinse,  Transversospinales. 
Scaleni,  Serratus  magnus. 
Deltoid  (from  spine  of 
scapula).  Teres  maj..  In- 
fraspinatus, P  e  c  t  0  rails 
minor  and  maj.  (sternal)., 
Latissimus  dorsi,  Coraco- 
brachialis, Triceps,  Anco- 
neus, Ext.  carp.  rad.  long, 
et  brev.,  Pronat.  teres,  Ex- 
tensor comm.  dig.,  Ext. 
carp,  ulnaris,  Ext.  long, 
poll.,  Ext.  metac.  pollicis, 
Flex.  carp,  rad..  Flex, 
carp,  ulnar.,  Ext.  min, 
dig.  (slight).  Flex.  prop, 
digit..  Flex,  sublim.  digit, 
(slight).  Superficial  short 
thumb  muscles.  Extensor 
indicis  and  Teres  minor, 
and  Palmaris  longus,  in 
Macacus. 


Retraction  and 
strong  adduction 
at  shoulder,  with 
some  inward  rota- 
tion of  arm;  arm 
is  carried  across 
the  body;  exten- 
sion at  elbow; 
slight  flexion  at 
wrist,  with  some 
pronation ;  slight 
flexion  of  fingers; 
shoulder  is  drawn 
down;  slight  re- 
traction and  lat- 
eral flexion  of 
neck. 


230 


SPINAL  ADJUSTMENT 


AFFERENT  ROOT. 


No.  of 
Nerve. 


Skin. 


Muscle. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


C  VIII.  The  radial  side  of  the 

lower  two-thirds  0/  fore- 
arm; the  whole  of  the 
hand  and  wrist,  both 
back  and  front,  and  a 
small  piece  of  the  ulnar 
side  of  the  forearm  just 
above  wrist.  Destrtiction 
of  this  root — Jar(je  as  it 
is — produces  no  anesthe- 
sia anywhere. 


Same 

Same 

as 

as 

motor. 

motor 

Triceps 

tap. 

Adduction   and  Ranges 

flexion  of  thumb  ;    bet  ween 
flexion  of  0  t  h  e  r    top     of 
digits;  flexion  or    fifth   and 
often  extension  at    top  of  sev- 
wrist;  dratcinp    enth   spin. 
inwards    and    proc. 
downward   of 
shoulder;   retrac- 
tion   of    upper 
arm  ;  at  e  I  b  0  ic 
sometimes    exten- 
s  i  0  n,  sometimes 
flexion. 


D  I.  The  ulnar  side  of  the 

hand,  including  three 
fingers  of  that  side;  the 
ulnar  side  of  the  fore- 
arm, including  the  skin 
over  the  olecranon.  De- 
struction of  this  root 
causes  a  patch  of  anal- 
gesia on  ulnar  side  of 
flexor  aspect  of  forearm. 


Same 

as 

motor. 

Triceps 

tap. 


Move  ment  at 
shoulder,  s  o  m  e- 
times  retraction; 
contraction  of  tri- 
c  e  p  s  in  part; 
flexion  of  digits 
with  adduction  of 
thumb;  extension 
at  el  b  0  IV,  some- 
times  flexion ; 
some  flexion  and 
pronation  at 
wrist. 


Ranges 
bet  ween 
above 
sixtb  and 
below  sev- 
enth spin, 
proc. 


D  IT.  The  inner  and  poste- 

rior aspect  of  the  upper 
arm  and  the  inner  aspect 
of  the  highest  quarter  of 
t  h  e  forearm,  including 
the  inner  condyle  and 
the  bracMal  wall  of  the 
axillary  space. 


Same 

as 
motor. 


Heart 
(ven- 
tricle) 
and 
lungs. 


M  o  V  e  ment  at 
slioulder;  slight 
flexion  of  thumb 
and  digits;  some- 
times contraction 
in  triceps;  some- 
times dilatation 
0  f  homonymous 
pupil. 


Ranges 
from  low- 
er edge  of 
sixth  cerv. 
spine  to 
that  of 
first   dors. 


D  III.  Zone  passing  from 

sternum  to  back,  sweep- 
ing round  close  above 
nipple  and  bounded  by 
axial  lines  of  limb  above. 
Sirecps  down  axillary 
aspect  of  upper  arm  half- 
>ray  to  elbow.  Over  mid- 
dle of  scapula  and  over 
third  rib  inside  mamniil- 
lary  line  (Head). 

D  IV.  Zone   of  skin  passing 

round  chest,  including 
axilla  (lower  part)  and 
nipple.  Reaches  axial 
lines  only  near  mid-dor- 
sal and  m  i  d-v  enter. 
Width  of  band  is  from 
third  intercost.  space 
down  to  sixth  rib  (Mer- 
tens). 

D  V.  Zone  behind  lies  just 

over  angle  of  scapula; 
its  upper  edge  rises  to 
include  nipple.  Head 
finds  this  the  field  to 
which  nipple  really  be- 
longs in  man.  Width 
extends  from  fourth  rib 
to  top  edge  of  seventh 
IMertens). 


Same 

Heart 

as 

(ven- 

motor. 

tricle) 

and 

lungs. 

Same 

as 
motor. 


Heart 
(ven- 
tricle) 

and 
lungs. 


Retraction  o  f 
shoulders;  c  o  n- 
trac.  of  part  of 
triceps. 


Retraction  o  f 
shoulder;  o  c  c  a- 
sionully  contrac- 
tion of  triceps. 


Ranges 
from  up- 
per edge  of 
s  e  v  enth 
cerv.  spine 
t  o  lower 
edge  of 
second 
dorsal. 


Ranges 
from  top 
edge  of 
first  dors, 
spine  to 
that  of 
third. 


Same 

Heart 

2Iuscles  of  back 

Ranges 

as 

and 

and  side  of  chest; 

from   top 

motor. 

lungs. 

the  i  n  t  e  r  costal 

edge    of 

spaces      involved 

second    to 

are    chiefly    flfth 

top     of 

and   sixth;   occa- 

fourth 

sional   retrac.    of 

dorsal 

shoulder. 

spine. 

SEGMENTATION  AND  LOCALIZATION 


231 


EFFERENT  ROOT. 


Striped  Muscle. 


Chief  Movement 
Effected. 


Blood- 
vessels. 


Clauds  of 
Viscera. 


Ix)ngus  colli,  Erector 
spinas,  Transversospinales, 
Serratus  magnus,  Scalcni, 
Pectoralis  minor  and  maj. 
(sternal  part),  Latissim. 
dorsi.  Triceps,  Anconeus, 
Extensor  carpi  ulnaris. 
Flexor  carpi  radialis,  Flex, 
carp,  ulnar..  Extensor  in- 
dlcis,  Exten.  communis 
digit.,  Ext.  long,  pollicis, 
Ext.  metac.  pollicis,  Ext. 
min.  digit.,  Palmaris  long.. 
Flex.  long,  pollicis.  Flex, 
prof,  digit..  Flex,  sublim. 
digit.,  Superficial  and  deep 
short  muscles  of  thumb 
and  little  finger,  the  three 
most  radial  lumbricales 
and  palmar  interossei  and 
all  the  dorsal  interossei. 
Pronator  quadratus. 

Erector  spinse.  Levator 
costse,  Transversospinales, 
Serratus  postic.  sup.,  In- 
tercost.,  Scaleni,  Pector. 
ma.  et  min..  Triceps, 
Latiss.  dorsi,  Flex.  carp, 
ulnar..  Pronator  quad- 
ratus. Flexor  long,  poll., 
Flex.  prof,  et  sublim.  digi- 
tor.,  Palmaris  long.,  Ext. 
minimi  digiti,  Lumbricales 
and  interossei,  Short  mus- 
cles of  thumb  and  of  little 
finger.  Extensor  carpi  ul- 
naris in  Macacus. 

Erector  spinfe,  Levator 
costse,  Transversospinales, 
Serratus  postic.  sup.  Sca- 
leni, Intercostales,  Flej-or 
long,  pollic.  Flex,  sublim. 
et  prof,  digit.,  deep  short 
muscles  of  thumb,  short 
muscles  of  little  finfjer ; 
Interossei  a  n  d  lumbri- 
cales; in  Macacus. 

Erector  spinae,  Levator 
costse,  Transversospinales, 
Intercostales,  S  e  r  r  a  tus 
posticus  superior,  Trian- 
gularis sterni. 


Shoulder  drawn 
doivn;  some  ad- 
duction of  shoul- 
der; rotation  in- 
\rard  of  arm; 
flexion  and  prona- 
tion at  w  r  I  *•  /  ; 
flexion  of  fingers 
and  of  thumb 
with  opposition. 


Retraction  o  f 
■■ihoulder;  slight 
lateral  flexion 
and  retraction  of 
neck;  slight  ex- 
tension at  elbow ; 
flexion  at  uyrist 
w  i  t  h  pronation; 
slight  abduction 
of  wrist  at  ulnar 
s  I  d  e;  flexion  of 
fingers  and  thumb 
ir  i  t  h  opposition 
of  latter. 


Retraction  o  f 
shoulder;  slight 
flexion  of  wrist ; 
flexion  of  fingers 
and  thumb  with 
opposition  of  lat- 
ter; lateral  curv- 
ing of  the  spinal 
column. 


T  h  r  o  u  g  li 
c  o  n  n  e  c  tion 
with  sj'nipa- 
t  h  e  t  i  c  sup- 
plies V  i  s  cera 
as  s  h  o  w  n  in 
chapter  on 
Innervation. 


Slight  to 
vessels  of  head 
on   same  side. 


Bl  00  d-ves- 
sels  of  face 
and  head  on 
same  side 
(tongue,  ear, 
gums,  thyroid, 
etc.);  acceler- 
ation of  heart. 


As  for  D  II., 
and  vasomotor 
to  I  u  n  g  s. 
?  V  a  s  o  m.  to 
hand. 


T  h  r  o  u  g  li 
e  o  n  n  e  c  tion 
with  sympa- 
t  h  e  1 1  c  sup- 
plies vis  cera 
as  s  h  o  w  n  in 
chapter  on 
Innervation. 


Dilatation  of 
pupil  with 
widening  o  f 
p  a  1  p  e  b  r  a  1 
opening. 


Dilatation  of 
pupil :  opening 
p  alp  eb  r  al 
fiss. ;  secretion 
o  f  submaxill. 
gland. 


Slight  dilat. 
of  pupil;  open- 
ing of  palp, 
fiss.;  secret, 
from  Whar- 
ton's duct. 


Same  as  D  III. 


As  for  D 
III.,  but  slight- 
er effect,  ex- 
cept to  lungs, 
where  strong- 
er, vasomiitiir 
to  hand. 


Slight  open- 
ing palp.  ^«.v.  .• 
secret.  Whar- 
ton's duct; 
sweat  glands 
of  arm  and 
hand. 


Erector  Spinse,  Levator 
costse,  Transversospinales, 
Intercostales,  Triangularis 
sterni,  Obliq.  extern,  abd., 
Rect.  abdom. 


Slight  to 
vessels  of 
head  and  face; 
to  forearm 
and  hand 
(strong), lung; 
slight  acceler- 
ation of  heart; 
slight  con- 
s  t  r  i  ction  of 
portal  vein. 


S  u  b  maxill. 
s  ecretion 
(slight):  sweat 
glands  of 
h  and;  co  n  - 
tract. of  spleen. 


22>2 


SPINAL  ADJUSTAIENT 


AFFERENT  ROOT. 


No.  of 
Nerve. 


Skin 


Muscle. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


D  VI.  Lower  border  of 

zone  runs  from 
eighth  dorsal  spiiio 
to  end  in  front  below 
the  attachment  o  i' 
the  xiphoid  cart 
(Head). 


Same 


Heart,  lungs, 
stomach  (car- 
diac end) ,  hile 
duct  and  yall 
bladder. 


Muscles  of  back 
and  side  of  chest ; 
the  i  n  t  e  r  costal 
spaces  incolved 
are  chiefly  fifth 
and  sixth;  occa- 
sional retrac:  of 
shoulder. 


Ranges  from 
lower  edge  of 
second  dors, 
spine  to  upper 
of  fifth. 


DVIL  L  o  w  e  r  border  of      Same 

zone    at    ninth    dors.  as 

spine  passes  to  end  motor, 
at  junction  of  upper 
with  middle  third  of 
space  between  xiphoid 
and  umbilicus 
(Head). 


DVIII         L  0  w  e  r  border  of      ^ame 
zone  at  eleventh  dors.  ^^ 

spine  to  end  in  front  motor, 
at  junction  of  middle 
with  lowest  third  of 
space  between  xiphoid 
and  umbilicus 
(Head). 

D  IX.  Lower  border  of      Same 

zone  at  twelfth  dors.  as 

spine  to  end  in  front  motor, 
at  the  umbilicus 
(Head).  According  to 
Head  the  umbilicus 
lies  between  ninth 
and  tenth  dorsal 
fields. 

D  X.  Lower  border  of      Same 

zone  at  third  lumbar         as 
spine  to  end  in  front     motor, 
midway   down   be- 
tween umbilicus  and 
symphysis  (Head). 

D  XI.  Lower  edge  of  zone      Same 

at  fifth  lumbar  spine  as 
to  end  in  front  at  motor, 
junction  of  m  i  d  d  I  e 
and  lower  thirds  of 
space  between  sym- 
physis and  umbilicus 
(Head).  The  groin 
just  above  Pourpart's 
lig.  lies  in  this  field. 

D  XII.  Lower  edge  of  zone      Same 

crosses  below  crista  as 
ilii  and  on  the  outer  motor, 
s  i  d  e  of  thigh  below 
Pourpart's  ligament ; 
this  border  gives  a 
characteristic  short 
tongue-shaped  flap  on 
front  of  thigh.  The 
first  lumbar  field  of 
Macacus  corresponds 
Kith  Man's  D  XII. 


Heart  (auri- 
cle), lungs, 
stomach 
(card,  end), 
liver,  and  gall 
bladder. 


Heart  (auri- 
cle), lungs, 
stomach,  liver, 
and  gall  blad- 
der. 


Muscles  of  back 
and  side  of  chest; 
some  of  the  more 
super  ficial  re- 
spond more  read- 
ily than  do  those 
of  the  intercost. 
space.  Those  of 
the  seventh, 
eighth,  and  sixth 
spaces  do  re- 
spond. 


Stomach        Epigastric     re- 
(pyloric),    liv-    flex  (Dinkier), 
er,'   gall    blad- 
der and  intes- 
tine. 


Ranges  from 
top  of  fourth 
t  o  bottom  o  f 
fifth  dorsal 
spine. 


Ranges  from 
top  of  fifth  to 
top  of  sixth 
spinous  p. 


Ranges  from 
midway  be- 
t  w  e  e  n  fifth 
and  sixth  dor- 
sal spines 
down  to  top  of 
seventh. 


Liver,  gall 
bladder,  intes- 
tine, prostate, 
testis,  ovary, 
kidney,  and 
top  of  ureter. 

I  n  t  e  s  tine, 
kidney,  ureter, 
prostate,  epi- 
didymis, and 
uterus  (not 
OS),  ovarian 
appendages. 


Dilatation      of        Ranges  from 

renal     vessel  s    lower   edge   of 

c  har  a  ct  eristic    sixth  to  upper 

(Bradford).  of  eighth  dors. 

spine. 


Muscles  of 
flank,  a  b  d  o  men 
a  n  d  intercostal 
space;  renal  dila- 
tation character- 
istic. With  mod- 
erate s  t  i  m.  no 
movement  of 
limbs. 


Ranges  from 
top  of  seventh 
dors,  spine  to 
top  of  eighth. 


I  n  t  e  s  tine.        Muscles   of  Ranges  be- 

kidney,  ureter,  flank    contract;    tween  top  of 

e  p  i  d  i  dymis,  retraction    of  ab-    eighth    dors, 

uterus  (not  dominal  wall  loir    spine  and  bot- 

os),     urinary  doicn;  flexion  at    torn  of  ninth, 

bladder,     ova-  hip;  renal  dilata- 

rian    append-  tion   char  acier- 

ages.  istie. 


SEGMENTATION  AND  LOCALIZATION 


233 


EFFERENT  ROOT. 


Striped    Muscle. 


Chief  Movement 
Effected. 


Blood- 
Vessels. 


Glands  of 
Viscera. 


Same  as  D  V. 


Erector  spina;,  Leva- 
tor costse,  Transverso- 
spinal, Subcostalis,  In- 
tercostales,  Obliq.  ext. 
abd.  et  int.  abd..  Rectus 
abd.  and  Transvers. 
abd. 


Same  as  D  VII. 


Retraction  o  f 
shoulder;  slight 
flexion  of  wrist; 
flexion  of  fingers 
and  thumb  icilli 
opposition  of  lat- 
ter; lateral  curv- 
ing of  the  spinal 
column. 


Constriction 
in  forearm  and 
h  an  d,  lung, 
liver,  portal 
system,  pan- 
creas and  in- 
t  e  s  t  i  n  e  ; 
slightly  in 
kidney. 

Of  I  u  n  (I 
slip  htly,  of 
hand,  portal 
system,  liver, 
pancreas  and 
intestine 
strongly,  of 
kidney  dis- 
tinctly. 

Of  forearm 
and  hand,  por- 
tal system, 
kidney,  liver, 
pancreas  and 
intestine. 


Secretion  in 
sweat  glands 
of  hand;  con- 
traction of 
spleen. 


Sweating  of 
hand;  mo-re- 
nt ent  of  spleen 
and   intestine. 


Sweating  of 
hand;  move- 
ments in 
spleen  and  in- 
testine. 


Erect,  spin.,  Lev.  cost., 
Transv.  spin.,  Subcos- 
tales,  Intercost.,  Obllq. 
ext.  et  int.  abd.,  Trans- 
versus  abd.,  Rect.  abd., 
Serrat.   post.   inf. 


Of  forearm 
and  hand 
(slip  h  t),  of 
portal  venous 
system,  liver, 
pancreas,  in- 
testine, and 
kidneys. 


Sweating  of 
hand;  mo  ve- 
nt e  n  t  s  i  n 
spleen  and  in- 
testine. 


Same  as  D  IX. 


Of  kidney, 
liver,  pancreas 
and    intestine. 


Movements 
in  spleen  and 
intestine. 


Same  as  D  IX. 


Of  liver, 
pancreas  and 
intestine ; 
constriction  in 
leg  and  foot 
(slight). 


Movements 
in  intestine; 
siren  ting  of 
foot  (slight). 


Erect,  spin., Lev.  cost., 
Transv.  spin.,  Subcos- 
talis,  Intercostales,  Ob- 
liq. ext.  et  Int.  abd., 
Transvers.  abd.,  Rect. 
abd.,  Pyramidalis 
(Quadratus  lumborum). 


Retraction  o  f 
abdominal  wall; 
no  movement  of 
limb. 


Of  liver, 
pancreas. 
imtesPine,  leg 
and  foot. 


Movement 
of  intestine: 
streat  glands 
of  foot. 


234 


SPINAL  ADJUSTMENT 


AFFERENT  ROOT. 


No.  of 
Nerve. 


Skin. 


Muscle. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


LI.  S  e  c  0  n  d  lumh.  of      Same 

M  acacus  (=Man's         as 
L  I.).  motor. 

Lower  edge  of  zone 
sweeps  from  sacrum 
across  huttock  ahoiit 
midway  h  et  w  ee  n 
gluteal  fold  a  n  d 
crista  ilii,  comes 
more  than  one-third 
down  front  of  thigh 
and  recurves  to  sym- 
physis. 

^  ^^"  L  III.  of  Macacus      Same 

(=L  II.  of  Man).  ^s 

Lower  edge  sweeps  motor. 
from  dorsal  aa-ial  line 
of  limb  over  outer 
side  of  thigh  a  n  d 
passes  across  close 
above  or  on  patella 
to  return  along  the 
adductors  and  ven- 
tral axial  line  to 
symphysis. 

L  111-  L  IV.  Macacus  (^    Knee- 

L  III.  Man).  Jerk. 

From  the  d  0  r  s  a  1     Name 
axi  a  I   line  of  limb         as 
sweeps  over  ilium     motor. 
down  extensor  face 
of   thigh,   over   knee 
and  inner  face  of 
highest  half  of  leg  to 
the  ventral  axial  line 
of  the  limb  at  the  in- 
ner edge  of  thigh,  i. 
e.,  skin  coverin  g 
gracilis   and  inner 
line  of  attachment  of 
calf  muscles. 

L  IV.  L  V.  Macacus  (=L     Knee- 

IV.  Man).  jerk. 

Field  a  rough  isos-      Same 
celes  triangle  to  it  h         as 
apex  at   hallux,  and    motor. 
base  on  front  of  and 
halfway  up   thig  h, 
exhibiting    a    deep 
downioard  notchinit. 


Bladder,        Ret  raction  of  Ranges  be- 

iM-ostate,    epi-    abd.   wall;  slight  tween    top    of 

didymis,   and    flexion  at  hip,  re-  ninth    dors. 

uterus.  traction  of  testL-i ;  spine  and  bot- 

cremasteric  reflex,  tom  of  tenth. 


None  known. 


None  known. 


None  known. 


Curving   of  Ranges  be- 

body  toicard  side    tween  ninth 
stimulated;    flex-    and    eleventh 
ion  at  hip,  rarely    dors,  spines. 
at    knee;    retrac- 
tion of  test  i  s; 
c  r  e  m  asteric  re- 
flex. 


Curving  of  Ranges  be- 

body  toicard  side   tween  t  o  p  of 
stimulated;    flex-    tenth  and  bot- 
ion  at  hip,  and  at    t  o  m   o  f  elev- 
knee;    flexion    of    enth    dors. 
h  a  I  lux  occasion-    spine. 
ally ;  adduction 
at   hip;  rarely 
slight    dorso- flex- 
ion at  ankle. 


Flexion  at  hip, 
at  knee,  and  of 
toes,  often  slight 
dorso-flexion  a  t 
ankle;  adduction 
at  hip  often  as  a 
crossed  effect; 
glutcel  reflex. 


Ranges  be- 
tween bottom 
of  tenth  and 
top  of  twelfth 
dors,    spine. 


^  V.  Field    i  ncl  u  d  e  s 

whole  of  f  o  o  t  a  n  d 
ankle,  but  ivhile  bare- 
ly comprising  the  in- 
tern, malleolus, 
sweeps  up  the  pero- 
neal side  of  the  leg  to 
reach  the  outer  ham- 
string at  the  knee. 
Area  resembles  a  sock 
tvith  oblique  upper 
edge. 


Flexion    at 

Same  Prostate,         knee;  flex,  of  hip  Ranges  be- 

as  yith   some   inter-    tween  t  o  p  of 

motor.  nal  rotation;  flex-    eleventh    dors. 

ion  of  hallux  and  spine  and  top 
other  digits;  of  twelfth. 
dors  o-flex.  o  f 
ankle  with  tilting 
outward  of  foot; 
crossed  adduction 
of  thigh;  glutwal 
reflex;  plantar  re- 
flex. 


SEGMENTATION  AND  LOCALIZATION 


235 


EFFERENT  ROOT. 


Striped  Muscle. 


Chief  Movement 
Effected. 


Blood- 
vessels. 


Glands  of 
Viscera. 


Erect,  spin.,  Lev.  cost., 
Transv.  spin.,  Quadra- 
tus  lumboruiu,  Obliq. 
abd.  internus,  Transv. 
a  b  d  o  m.,  Pyramidalis, 
Cremaster  (Psoas  maj., 
Psoas  min.). 


Retraction  of 
nhdominat  wall; 
sUiiht  flexion  at 
hip. 


Liier,  pan- 
creas, intes- 
tine, leg,  and 
loot. 


Movement 
of  intestine 
and  hladder ; 
intern,  sphinc. 
ani  contracts  ; 
stceat  {/lands 
of  f  o  0  t;  vas 
deferns  and 
ves  s  e min  ; 
uterus. 


Erector  spin.,  Lev. 
cost.,  Transv.  spin., 
Quad,  lumb..  Psoas  ma. 
et  mi.,  Iliacus,  Pecti- 
neus.  Gracilis.  Sartorius 
(upper  part  only).  Add. 
long,  et  brev.,  Cremas- 
ter. Data  largely  ex- 
perimental. 


Erector  spin..  Multi- 
fid,  spin..  Psoas  ma.  et 
mi.,  Iliacus,  Pectineus, 
Obturator  e  x  t.,  A  d  d. 
magnus,  brevis,  longus, 
Sartorius  (esp.  lower 
part).  Vastus  media- 
ns. Rectus  f  e  m  o  r  i  s. 
Vast,  lateralis.  Crureus, 
Gracilis.  Data  largely 
experimental. 


Retraction  o  f 
lower  part  of  ah- 
dom.  wall  and 
testis;  flexioti  at 
hip. 


Of   leg  and 
foot. 


Retraction  a  f 
part  of  ahdom. 
irnll ;  flexion  and 
adduction  at  hip; 
extension  at 
knee. 


None. 


Movement 
of  hladder  and 
intestine;  int. 
sphinc.  ani 
c  0  n  t  r  acts  ; 
stceat  glands 
of  foot; 
uterus;  con- 
tract, of  round 
ligament;  vas 
d  e f  er ens  ; 
vesic.  semi- 
nalis. 

None. 


Erector  spin..  Multi- 
fid,  spin..  Rectus  fcm.. 
Vastus  med.  et  lat., 
Crureus,  Gracilis,  Ob- 
turat.  ext.,  A  d  d  u  c  t, 
magn.  et  brevis.  Quad, 
femoris.  Tensor  fascife 
femoris.  Tibialis  anti- 
cus,  Ext.  long,  digito- 
rum,  Ext.  proprius  hal- 
lucis.  Semimembranosus 
(slight),  Glutaeus  med. 
et  min.  Data  largely 
experimental. 

Erector  spin..  Multi- 
fid,  spin..  Tibial,  ant., 
Ext.  long,  dig.,  Ext. 
hall.,  Glutaeus  max. 
med.  et  min.,  Peroneus 
long.,  Exten.  brev.  dig., 
Gast.  (outer  head  more 
than  medial).  Tibialis 
post..  Flex.  long,  digi- 
tor..  Flex.  long,  hallu- 
cis.  Semimembranosus, 
Adduct.    magnus     (con- 


Adduction  at 
hip  ;  extension  at 
knee;  some  dor- 
so-flexion  at  an- 
kle, and  some 
extension  of  hal- 
lux. 


Extension  a  t 
h  i  p ;  adduction 
of  thigh;  weak 
flexion  at  knee; 
dorso-flexion  a  t 
ankles ;  extension 
of  toes;  adduc- 
tion  of   hallux. 


None. 


None. 


None. 


None. 


236 


SPINAL  ADJUSTMENT 


AFFERENT  ROOT. 


No.  of 
Nerve. 


Skin. 


Muscle. 


Viscera. 


Reflex  Movement. 


Level  of 
Surface 
Origin. 


SI.  A  long  field  includ-      Foot 

ing  the  four  outer   clonus. 
digits,  the  outer  two-      (Zic- 
thirds  of  the  sole,     hen). 
the  posterior  aspect 
of  the  ankle,  the  calf 
and  the  lower  three- 
fourths   of   the   back 
of  the  thigh. 


Prostate.             Flexion    at  Ranges  be- 

l:nee;    flexion    at  tween      lower 

hallux  and  digits  ;  border      of 

dors  o-flexion  of  eleventh   dors. 

ankle;  very  rare-  spine  and  top 

ly  plantar  flexion ;  of   first   lumb. 
plantar  reflex. 


S  II.  Back  of  tliigh  from 

behind  the  knee 
(sometimes  upper 
part  of  calf)  up  to 
the  ischial  tuberosity 
and  fold  of  the  but- 
tock. 


Foot  P  r  o  s  t  ate,         Flexion    of  Usually  be- 

clonus.  bladder,    r  e  c-     digits;     slight  tween   twelfth 

Same  turn,  os  uteri,    flexion  of  knee;  dors,  and  first 

as  pr  otru  sion    of  lumbar  spines, 

motor.  anus. 


S  III.  Patch  covering  peri-  Same 

7ieum    a  71  d    buttock         as 

and    sweeping    for-  motor. 
ward  over  under  sur- 
face of  scrotum  and 
penis. 

S  IV.  Triangular    patch.  Same 

ivith  apex  laterally,        as 

lying  on  sacrum.  motor. 


Frost  ate, 
bladder,  r  e  c- 
tum,  OS  uteri. 


P  r  0  s  t  ate, 
bladder,  r  e  c- 
tum,  OS  uteri. 


Protrusion  o  f 
anus;  flexion  of 
hallux;  anal  re- 
flex. 


Protrusion     o  f 
anus;  anal  reflex. 


SEGMENTATION   AND   LOCALIZATION 


237 


EFFERENT  ROOT. 


Striped  Muscle. 


Chief  Movement 
Eflfected. 


Blood- 
vessels. 


Glands  of 
Viscera. 


dylar  portion),  Semi- 
tendinosus.  Biceps  (cap. 
long)  ;  Quadratus  femo- 
rls,  Gemell.  sup.  et  inf., 
Plantaris,  Popliteus,  Ab- 
ductor hallucis,  Flex, 
brev.  dlgitorum,  Obtur. 
int.  (Pyriformis,  Ab- 
ductor min.  digiti,  and 
Soleus,  all  very  slightly 
innervated).  Data  larye- 
ly  experimental. 

Multifld.  spin.,  Glutfci 
max.  med.  et  min.,  Py- 
riformis (esp.  lateral 
part).  Biceps  (caput 
breve  and  longe).  Semi- 
membranosus, Semiten- 
dinosus.  Gemellus  supe- 
rior, Peroneus  brevis, 
Peroneus  longus  (slight- 
ly), Extens,  longus  digi- 
torum,  Extens.  brevis 
dlgitorum,  Ext.  b  r  o  v. 
hallucis.  Gastrocnemius, 
Popliteus,  Plantaris, 
Flex.  long,  digit..  Flex, 
long,  hallucis,  Soleus, 
Tibialis  posticus,  Flexor 
brevis  digit.,  Abduct., 
hallucis.  Abduct,  min. 
digit..  Flex,  accessorius, 
Flex.  brev.  hall.,  Flex, 
brev.  min.  digit..  Ad- 
duct,  hallucis  (Quad- 
rat, fem.  slightly),  Ext. 
sphincter  ani.  Sphinc- 
ter vaginae,  Lumbricales 
and  interossei.  Obtura- 
tor internus.  Data  large- 
ly experimental. 

Multifldus  spin.,  Glu- 
taeus  max..  Biceps  (both 
heads),  Semitendinosus, 
Semimembranosus,  Gas- 
trocnemius, Soleus,  Ab- 
ductor hallucis.  Flex, 
brev.  digit..  Flex,  acces- 
sor.. Abductor  minim, 
digiti.  Adductor  hallu- 
cis. Obturator  internus, 
Pyriformis  (small  me- 
dial part).  Flex.  brev. 
hallucis.  Flex.  brev. 
min.  digit.,  Lumbricales 
and  Interossei,  Ext. 
sphincter  ani,  and 
Sphincter  vaginae.  Data 
largely  experimental. 

Multifldus  splnae,  etc., 
Levator  ani.  Sphincter 
ani  (in  some  individ- 
uals), Perineal  muscles. 

Levator  ani,  Perineal 
muscles. 


Flexion  at 
Ic  n  e  e;  extension 
usually  (i.e.  plan- 
tar flexion)  a  t 
ankle  J  inversion 
of  sole;  strong 
flexion;  adduc- 
tion of  hallux; 
moi^ement  of 
anus. 


Flexion  at  knee; 
extension  at 
ankle;  flexion  of 
toes;  movement 
of  anus. 


Perineal. 


Perineal. 


None  known 
accurately. 


Dilator  t  o 
genitalia  and 
lower  rectal 
muc.  memh. 


Dilator  1 0 
genitalia  and 
lower  rectal 
muc.  memh. 


Pro  trusion 
and  erection 
of  penis; 
slight  cont.  of 
bladder. 


Contraction 
of  bladder; 
protrusion  and 
erection  of 
penis  with 
turgor  ;  de- 
scending colon 
and  rectum ; 
int.  sphinct. 
and  relaxes. 


Contraction 
of  bladder; 
turgor  of 
p  e  n  i  s  ;  de- 
scending colon 
a  n  d  rectum  ; 
int.  sphinct, 
ani  rela.res. 


238  SPINAL  ADJUSTMENT 

The  following  table  shows  the  relation  of  the  vertebral 
spinous  process  to  the  segments  of  the  spine. 

Cervical  Segments  Spinous  Processes 

1st  1 

-  , V  Posterior  tubercle  of  atlas. 

Znd    J 

I  Spinous  process  of  axis. 
4th    J     ^  ^ 

5th    Spinous  process  of  3rd  cervical. 

6th    Spinous  process  of  4th  cervical. 

Q  ,     ^Spinous  process  of  5th  cervical. 

Thoracic  Segments 

^    , I  Spinous  process  of  6th  cervical; 

2nd    J 

3rd  Spinous  process  of  7th  cervical. 

4th  Spinous  process  of  1st  thoracic. 

5th  Spinous  process  of  2nd  thoracic. 

6th  Spinous  process  of  3rd  thoracic. 

7th  Spinous  process  of  4th  thoracic. 

8th  Spinous  process  of  5th  thoracic. 

9th  Spinous  process  of  5th  thoracic. 

10th  Spinous  process  of  6th  thoracic. 

11th  Spinous  process  of  7th  thoracic. 

12th  Spinous  process  of  8th  thoracic. 

Lumbar  Segments 

1st Spinous  process  of  9th  thoracic. 

-  ,    ^  Spinous  process  of  10th  thoracic. 

3rd    J 

4th    

5th    

Sacral  Segments 

1st 

2nd    

3rd    

4th    

5th    

Coccygeal  Segment 

1    Spinous  process  of  1st  lumbar. 


y Spinous  process  of  11th  thoracic. 


^-Spinous  process  of  12th  thoracic. 


CHAPTER  II 

Spinal  Symptomatology 

Having  considered  the  normal  spinal  column,  vve  will 
now  direct  our  attention  to  a  study  of  those  changes  which 
occur  in  the  spine  and  its  ligaments,  the  anatomical  structures 
connected  with  it,  and  various  subjective  symptoms  resulting 
from  subluxations  of  the  vertebrae.  These  various  signs  and 
symptoms  referable  to  the  spine  and  the  parts  governed  by 
the  nerves  of  the  different  segments  of  the  spine  point  to 
vertebral  subluxations  in  various  segments,  and  are  of  great 
assistance  in  making  a  correct  spinal  analysis. 

As  stated  in  a  previous  section  of  this  work,  proper  atten- 
tion has  been  given  by  the  medical  profession  to  symptoms 
indicating  gross  spinal  deformities,  such  as  Pott's  disease, 
scoliosis  from  occupation,  habits,  or  injury,  and  lordosis,  but 
those  symptoms  referring  to  the  possible  existence  of  dis- 
placements involving  a  single  vertebra  instead  of  a  group, 
have  been  left  uninvestigated.  In  many  cases  these  symptoms 
point  so  clearly  to  the  evident  existence  of  an  interference 
with  the  nerve-supply  of  a  part  that  it  is  surprising  that  the 
seat  of  this  interference  should  for  so  long  a  time  have  re- 
mained unsought  for  and  unfound. 

To  practitioners  of  spinal  adjustment  a  general  knowledge 
of  the  symptoms  pointing  to  a  vertebral  subluxation  are  very 
important ;  first,  they  give  an  accurate  knowledge  of  the  ex- 
istence of  a  lesion  and  its  location ;  second,  without  such  a 
knowledge  proper  correction  of  the  diseases  produced  by  the 
lesion  through  adjustment  of  the  lesion  is  impossible. 

The  symptoms  and  signs  which  indicate  the  existence  of  a 
vertebral  subluxation  are  the  following : 

1.  Mal-alignment  of  the  vertebrae. 

2.  Contraction  of  the  spinal  muscles  and  ligaments. 

3.  Diminished  mobility  of  the  back. 

4.  Pain. 

239 


240  SPINAL  ADJUSTMENT 

5.  Tenderness. 

6.  Symptoms    referable    to    certain    organs,    systems,    or 
parts  of  the  body, 

7.  Local  zone  of  increased  temperature. 

8.  Thickening  of  the  nerve  trunks. 

9.  Changes  in  anatomical  structures  connected  with  the 
spine. 

Mal-alignment  of  the  Vertebrae  as  a  Sign  of  Vertebral  Sub- 
luxations.— By  mal-alignment  of  vertebrae  is  meant  especially 
that  of  the  spinous  processes,  as  found  by  examination. 
Normally  the  spinous  processes  should  be  either  seen  or  felt 
to  be  in  perfect  alignment,  with  no  deviation  upward,  down- 
ward, anteriorly,  posteriorly,  or  to  either  side.  When  the  end 
of  a  certain  spinous  process  is  found  to  be  out  of  line  with 
the  one  above  and  below  it,  it  usually  indicates  the  presence 
of  a  corresponding  deviation  from  its  normal  position  of  the 
vertebra  of  which  it  is  a  part.  This  is,  however,  not  invariably 
true,  since  the  spinous  process  may  project  from  the  vertebra 
of  which  it  is  a  part  at  different  angles  from  the  normal.  For 
this  reason  it  becomes  necessary,  for  purposes  of  verifying 
the  findings  and  conclusions  from  inspection  and  palpation 
of  the  spinous  processes  to  carefully  palpate  the  transverse 
processes.  If,  for  example,  a  certain  spinous  process  pro- 
jects backward  beyond  the  one  above  and  below  it,  it  may 
indicate  that  the  entire  vertebra  is  displaced  posteriorly;  but 
it  may  also  be  merely  an  abnormally  long  spinous  process  re- 
sulting from  over-development,  as  is  frequently  seen  in  oste- 
ological  collections.  If,  however,  it  is  found  that  the  trans- 
verse processes  are  also  displaced  backward  beyond  those  of 
the  vertebra  above  and  below,  it  may  then  be  concluded  that 
the  vertebra  in  question  is  really  displaced  posteriorly. 

To  determine  mal-alignment  of  vertebrae  palpation  of  both 
the  spinous  and  transverse  processes  is  absolutely  essential 
in  every  instance.  The  subject  of  the  detection  of  mal-align- 
ment of  vertebrae  will  be  considered  at  full  length  in  the 
chapter  on  spinal  examinations.  This  is  the  foremost  symp- 
tom of  vertebral  subluxations,  and  the  one  which  will  receive 
the  greatest  attention.  The  finding  of  mal-alignment  of  a  cer- 
tain vertebra  makes  it  conclusive  that  a  subluxation  exists  in 


SPINAL  SYMPTOMATOLOGY  241 

that  segment  of  the  spine,  without  any  further  examination 
being  necessary,  and  all  other  symptoms  and  signs  are  of 
subsidiary  importance.  They  are,  however,  of  sufficient  im- 
portance to  demand  a  careful  study,  since  they  very  often 
give  the  first  evidence  that  a  subluxation  is  present,  when 
mal-alignment  is  not  evident  on  inspection,  and  the  spine  has 
not  been  palpated. 

Contraction  of  the  Spinal  Muscles  and  Ligaments. — At 
those  points  where  a  subhixation  exists  there  will  always  be 
found  a  contracted  condition  of  the  corresponding  ligaments 
and  muscles.  This  condition  is  sometimes  so  marked  that  it 
can  be  seen  on  inspection  of  the  spine,  but  is  usually  very 
readily  determined  by  palpation.  When  the  first  three  fingers 
of  each  hand  are  passed  down  the  spine,  along  the  sides  of  the 
spinous  processes,  there  will  be  noticed  at  certain  points  a 
thickening  of  the  muscles  and  ligaments.  This  contraction, 
as  shown  in  the  chapter  on  reflex  subluxations,  is  more  evi- 
dent on  one  side  of  the  involved  segment,  for  the  reason  that 
the  nerve-impulses  which  caused  the  tetanic  contraction  of  the 
muscles  were  stronger  on  one  side,  namely  that  on  which  the 
efiferent  impulse  following  irritation  of  the  nerve-endings  at 
the  periphery  entered  the  spinal  cord. 

It  can  be  considered  as  certain  that  where  such  contrac- 
tures are  found  there  will  be  a  misplacement  of  the  corre- 
sponding vertebra,  since  the  constant  contraction  of  the  liga- 
ments on  one  side  destroys  the  balance  that  should  exist  on 
both  sides,  and  the  vertebra  will  be  drawn  toward  the  side 
which  is  contracted. 

These  contractures  are  present  in  both  acute  and  chronic 
subluxations,  but  the  hard  and  indurated  condition  of  the 
muscles  and  ligaments  in  the  latter  case  serves  to  distinguish 
it  from  the  former. 

The  contracted  condition  of  the  muscles  may  not  only  be 
the  cause  of  a  reflex  subluxation,  but  is  also  present  in  those 
displacements  produced  by  other  causes,  as  enumerated  in 
the  chapter  dealing  with,  the  production  of  vertebral  mal- 
alignment. Muscular  rigidity  is  the  earliest  sign  in  nearly 
every  abnormal  condition  in  any  part  of  the  body,  and  it  is 
the  observance  of  such  rigidity  which  first  calls  attention  to 
the  presence  of  an  abnormal  condition.    All  abnormal  condi- 


242  SPINAL  ADJUSTMENT 

tions  produce  an  excessive  irritation  at  the  periphery,  result- 
ing in  increased  reaction  of  the  motor  nerves  which  produces 
the  muscular  rigidity.  Thus  muscular  rigidity  is  one  of  the 
earliest  signs  of  Pott's  disease,  and  persists  until  the  condi- 
tion is  cured.  It  is  most  pronounced  in  the  immediate  region 
of  the  affected  portion  of  the  spine,  although  it  also  extends  to 
some  distance  in  either  direction  along  the  back.  The  muscu- 
lar rigidity  accompanying  disease  in  any  joint  is  a  common 
observance,  and  illustrates  this  point. 

If,  therefore,  muscular  rigidity  is  a  constant  concomitant 
of  all  joint  lesions,  it  follows  that  it  must  also  occur  when  in- 
dividual vertebrae  are  affected.  Further,  if  its  presence  in 
any  region  of  the  body  points  undeniably  to  an  abnormal 
condition  of  that  part  of  the  body,  its  detection  in  certain 
segments  of  the  vertebral  column  also  indicates  an  abnormality 
there.  Whenever  there  is  noted  the  presence  of  muscular 
rigidity  about  any  joint  in  the  body,  it  is  at  once  concluded  by 
the  observer  that  a  lesion  of  that  joint  is  present.  It  follows 
therefore,  that  when  muscular  rigidity  of  the  muscles  and 
ligaments  about  a  certain  segment  of  the  spine  is  noted  that 
a  lesion  of  the  corresponding  vertebral  articulation  must  be 
present. 

Diminished  Mobility  of  the  Back. — This  is  a  very  im- 
portant sign  of  vertebral  subluxations,  and  is  of  itself  suf- 
ficient evidence  that  a  misplacement  must  exist.  Diminished 
mobility  of  any  portion  of  the  body  is  evidence  of  the  existence 
of  some  disease  process  in  that  region.  Thus  upon  the  slight- 
est involvement  of  one  of  the  joints  of  the  extremities,  there 
follow  muscular  rigidity  and  pain,  both  of  which  factors  oper- 
ate in  the  production  of  diminished  mobility  of  the  part  in- 
volved. 

If,  therefore,  diminished  mobility  is  an  indication  of 
disease  in  other  parts  of  the  body,  it  must  be  considered  in  the 
same  light  when  it  is  present  in  a  certain  segment  of  the 
spine.  When,  for  example,  the  nodding  of  the  head  cannot 
be  executed  freely  and  painlessly,  it  indicates  an  implication 
of  the  occipito-atlantal  articulation.  If  the  face  cannot  be 
turned  easily  from  one  side  to  the  other,  an  abnormality  of 
the  atlanto-axial  articulation  is  present.  If  flexion  of  the 
head  cannot  be  performed  freely  and  painlessly,  it  shows  that 


SPINAL  SYMPTOMATOLOGY  243 

there  is  present  a  subluxation  in  the  lower  cervical  region.  To 
determine  the  degree  of  motility  of  the  dorsal  region  of  the 
spine  the  subject  should  be  instructed  to  bend  forward,  with 
the  knees  held  stiff,  until  the  trunk  is  horizontal,  with  the 
hands  hanging  down.  The  operator  then  views  the  spine  with 
his  head  on  a  level  therewith,  and  notes  whether  either  side  of 
the  trunk  is  more  prominent,  either  generally  or  locally  in 
certain  segments  of  the  column.  The  patient  is  next  instructed 
to  bend  backward  as  far  as  possible,  and  any  local  contractures 
indicating  diminished  movement  in  that  part  of  the  spinal 
column  are  carefully  noted.  Lastly,  the  subject  is  instructed 
to  bend  toward  either  side  and  any  local  or  general  lack  of 
motility  is  looked  for. 

If,  when  the  patient  is  bending  forward,  there  is  restricted 
movement  or  lack  of  flexibility,  it  is  an  indication  that  there 
is  a  settled  condition  of  the  vertebral  column  or  that  the 
muscles  and  ligaments  thereof  are  contracted.  If,  instead  of 
bending  straight  forward,  the  spine  curves  toward  either  side, 
when  the  patient  bends  forward,  it  indicates  a  contracted  con- 
dition of  the  ligaments  and  muscles  on  one  side. 

Lack  of  mobility  of  any  portion  of  the  spinal  column  indi- 
cates contraction  of  the  ligaments  and  muscles  of  the  corre- 
sponding spinal  segment.  This  will  of  necessity  produce  a 
deviation  of  the  vertebra  toward  the  contracted  side  and  re- 
sult in  pressure  upon  the  structures  by  the  displaced  margins 
of  the  intervertebral  foramen  through  which  they  pass. 

Pain. — This  sympton  is  always  a  very  important  sign  of 
a  positive  lesion  in  some  part  of  the  body.  Usually  pain  exists 
at  the  location  of  the  lesion  which  produces  it.  Frequently, 
however,  there  is  no  pain  at  the  seat  of  the  lesion  but  the  sen- 
sation is  referred  to  distant  points.  Ordinarily  when  a  sub- 
luxation of  sufficient  severity  to  cause  marked  pressure  to  be 
brought  to  bear  upon  a  nerve  is  present,  there  will  be  pain  felt 
at  the  point  impinged.  More  often,  however,  the  patient  has 
no  subjective  sensation  of  pain,  but  tenderness  may  be  elicited 
by  pressure  over  the  afifected  area. 

This  has  long  been  a  mooted  question.  The  question  con- 
stantly arises:  Why,  if  a  nerve  is  pressed  upon,  is  there  no 
pain  at  the  point  of  pressure?  This  is  so  for  the  reason  that  in 
most  instances  pain  is  not  perceived  by  the  subject  at  its  seat 


244  SPINAL  ADJUSTMENT 

of  production,  but  is  referred  to  the  peripheral  distribution 
of  the  nerve.  Thus  when  pressure  upon  a  nerve  occurs  at  the 
point  of  its  emergence  from  the  intervertebral  foramen  no  pain 
may  occur  at  that  point  but  is  perceived  at  the  peripheral 
distribution  of  the  nerve. 

The  perception  of  pain  at  the  knee  in  cases  of  hip  disease 
is  the  most  common  example  of  referred  pain.  Very  often  in 
such  cases  the  patient  does  not  experience  the  slightest  pain 
at  the  seat  of  the  lesion  in  the  hip,  and  disease  of  that  joint  is, 
therefore,  frequently  overlooked.  It  is  for  this  very  reason 
that  no  pain  being  present  at  the  seat  of  a  subluxation  its 
occurrence  is  not  thought  of.  Whenever,  therefore,  pain  is 
complained  of  by  a  patient  in  a  certain  region  of  the  body,  the 
operator  should  alw^ays  look  carefully  for  a  subluxation  in 
that  spinal  segment  from  which  the  nerves  w^hich  supply  such 
a  painful  area  are  derived ;  in  most  instances  a  subluxation 
will  be  found  there. 

For  example,  a  patient  may  complain  of  pain  in  the  eye- 
ball ;  we  know  that  the  upper  cervical  and  also  the  upper  dorsal 
segments  communicate  wath  nerves  to  the  eye,  and  by  careful 
palpation  of  the  vertebrae  in  these  regions  of  the  spine  a  sub- 
luxation will  generally  be  found. 

Pain  thus  becomes  a  very  important  assistant  in  the  making 
of  a  correct  spinal  analysis,  not  alone  when  situated  at  the 
point  of  the  producing  lesion,  namely  the  impingement,  but 
also  when  referred  to  a  point  at  some  distance  from  this. 

Tenderness. — This  symptom  is  a  very  positive  indication 
of  the  existence  of  a  subluxation  in  the  area  in  wdiich  it  is 
elicited  by  pressure  upon  the  nerve.  Its  importance  as  a 
symptom  of  a  subluxation  is  that  immediately  after  correction 
of  the  displacement  of  the  vertebra  the  tenderness  disappears. 
Pain  and  tenderness  must  not  be  considered  synonymous, 
since,  although  tenderness  on  pressure  is  usually  manifested 
over  the  seat  of  pain,  this  is  not  always  true,  as  either  pain  or 
tenderness  may  exist  separately.  Pain  is  a  subjective  symptom 
felt  more  or  less  constantly,  while  tenderness  is  perceived  by 
the  patient  only  when  pressure  is  made  on  the  aiifected  part. 

Symptoms  Referable  to  Certain  Systems,  Organs,  or  Parts 
of  the  Body. — As  has  been  previously  stated,  perfect  function 
of  all  parts  of  the  body  is  dependent  principally  upon  proper 


SPINAL  SYMPTOMA  rOLOGY  245 

innervation.  When,  therefore,  the  nerve-supply  to  any  part  is 
interfered  with  by  inabiHty  of  the  nerves  to  conduct  impulses 
to  it,  improper  function,  with  its  attendant  symptoms  will 
ensue.  By  a  knowledge  of  the  innervation  of  every  part  of  the 
body  symptoms  referable  to  that  part  may  very  readily  be 
referred  to  the  spinal  segment  which  controls  it,  and  in  most 
instances  a  subluxation  will  be  found  at  that  point. 

Thus,  if  a  patient  complains  of  symptoms  referable  to  a 
gastric  disturbance,  careful  palpation  of  the  fifth,  sixth,  and 
seventh  thoracic  vertebrae  will  invariably  demonstrate  the 
existence  of  a  misplacement  of  one  of  these  vertebrae.  If 
together  with  this  some  of  the  other  previously  enumerated 
signs  of  vertebral  subluxation  are  found  to  be  present,  it  can- 
rrot  be  denied  that  a  misplacement  is  present,  and  that  it  has 
a  marked  bearing  on  the  disease. 

In  the  section  on  Practice  the  symptoms  of  disturbances 
of  the  various  organs  are  given,  and  by  referring  these  to  the 
proper  organ,  and  then  recalling  its  innervation,  and  finding 
the  vertebrae  subluxated  which  result  in  impingement  of 
these  nerves,  we  see  what  an  important  sign  of  sublu:jcations 
such  symptoms  are. 

If  disturbed  function  is  present,  we  know  that  it  is  due  to 
disturbed  innervation  of  the  involved  part;  we  know  further 
that  the  only  logical  place  where  interference  with  the  con- 
duction of  nerve-impulses  could  occur  is  at  the  point  where 
it  passes  between  movable  bones,  namely  through  the  inter- 
vertebral foramina.  Vertebral  subluxations  must  therefore  be 
considered  the  primary  factor  in  the  production  of  disturbed 
function,  not  discountenancing  the  secondary  or  contributing 
factors. 

The  wide  range  of  disorders  which  may  be  produced  can 
readily  be  appreciated  by  recalling  the  efTt'erent  functions  of 
nerves,  namely,  trophic,  motor,  secretory,  and  inhibitory  or 
augmentory. 

The  first  of  these  functions  of  the  nerves  is  their  influence 
on  nutrition.  This  in  its  broadest  sense  includes  digestion, 
respiration,  absorption,  and  metabolism.  The  great  number 
of  disorders  which  result  from  improper  digestion,  respiration, 
absorption  and  metabolism  thus  all  depend  for  their  produc- 
tion largely  upon  vertebral  mal-alignment. 


246  SPINAL  ADJUSTMENT 

The  second  of  the  functions  of  the  nerves,  namely  their 
influence  on  motion,  is  exceedingly  important,  for  upon  their 
motor  impulses  depend  the  proper  functioning  of  nearly  all 
parts  of  the  body — the  contraction  of  the  heart,  the  move- 
ments of  respiration,  the  movements  of  the  stomach  and  in- 
testines, the  secretions  of  the  glands,  and  so  on.  A  little 
thought  will  at  once  bring  to  mind  many  diseases  known  to 
result  from  disturbance  of  these  functional  activities,  and  it 
is  unnecessary  to  enumerate  them  here. 

The  third  function  of  the  nerves,  namely  secretory,  is  also 
important,  since  a  great  number  of  diseases  can  be  traced  to 
disordered  secretion.  This  is  apparent  when  it  is  recalled 
how  many  parts  of  the  body  are  engaged  in  this  function : 
Namely,  all  serous  and  synovial  membranes,  the  mucous  mem- 
branes with  their  special  glands,  as  the  buccal,  gastric  and 
intestinal  glands,  the  salivary  glands,  the  pancreas,  mammary 
glands,  liver,  lachrymal  glands,  the  skin,  the  kidneys,  the 
testes,  the  ovaries,  the  thyroid  gland,  the  adrenals,  the 
pituitary  body,  and  the  spleen. 

As  examples  of  the  last  of  the  functions  of  nerves,  namely 
their  influence  on  existing  action,  may  be  cited  the  inhibitory 
action  of  the  vagus  nerve  upon  the  heart. 

All  these  functions  of  the  nerves  merge  more  or  less 
closely  into  each  other,  and  a  vertebral  subluxation  which 
affects  the  power  of  conduction  of  a  certain  nerve  will,  there- 
fore, afifect  all  the  functions  of  the  parts  which  that  nerve 
controls.  Disturbances  of  functions  in  various  parts  of  the 
body  as  shown  by  the  symptoms  produced  thus  are  an  im- 
portant sign  of  mal-alignment  of  vertebrae.  They  point  to 
the  necessity  for  the  occurrence  of  a  subluxation,  and  also  to 
its  location.  Anyone  who  cares  to  do  so,  may  demonstrate 
this  for  himself,  on  any  clinical  case. 

Local  Zone  of  Increased  Temperature.— By  recalling  the 
functions  of  nerves  we  find  that  they  control  the  temperature 
of  all  portions  of  the  body.  The  temperature  of  the  skin 
varies  from  hour  to  hour  according  to  the  activity  of  the 
cutaneous  circulation.  The  vasomotor  nerves  of  the  sym- 
pathetic system  control  the  circulation,  and  when  their  func- 
tion is  in  abeyance,  vasodilation  with  increased  surface  tem- 
perature results.    Thus  when  a  spinal  nerve  is  compressed  by 


SPINAL  SYMPTOMATOLOGY  247 

the  margins  of  the  intervertebral  foramen  of  a  siil)kixated 
vertebra,  the  skin  of  the  corresponding  segment  of  the  back 
is  found  to  be  warmer.  Conversely,  whenever  a  certain  seg- 
ment of  the  back  is  found  to  be  warmer  than  the  adjacent 
segments,  a  subluxation  will  always  be  found  at  that  point. 

Thickening  of  the  Nerve  Trunks.- — In  palpating  the  ver- 
tebral column  along  the  laminae  the  nerves  will  sometimes 
be  felt  to  be  thickened.  This  is  due  to  a  thickened  condition 
of  the  sheath  of  the  nerve,  as  a  result  of  congestion  of  the 
spinal  segment  from  which  the  nerve  emanates. 

At  all  points  where  this  thickened  condition  of  the  nerves 
is  found  a  subluxation  will  always  be  located,  and  this  then 
becomes  another  important  sign  of  vertebral  mal-alignment. 

Changes  in  the  Anatomical  Structures  Connected  with  the 
Spine. — Subluxations  of  the  vertebrae  may  be  determined  by 
comparing  the  height  and  prominence  of  the  scapulae,  the 
prominence  of  the  angles  of  the  ribs,  and  the  prominence  of 
the  iliac  crests.  If  any  variation  on  the  two  sides  of  the  body 
is  noted,  it  indicates  that  a  subluxation  is  present,  and  is  an 
important  symptom,  and  valuable  aid  in  spinal  analysis.  The 
various  methods  for  eliciting  these  various  differences  from 
the  normal  will  be  discussed  in  detail  in  the  chapter  dealing 
with  the  examination  of  the  vertebral  column. 


CHAPTER  III 

Spinal  Diagnosis 

Spinal  diagnosis  is  the  determination  of  disease  in  a  cer- 
tain system,  organ,  or  part  of  the  body  by  the  detection  of  a 
vertebral  subluxation  which  interferes  with  the  conductivity 
of  the  nerves  supplying  that  part. 

Ability  to  make  a  correct  diagnosis  from  the  palpation  of 
a  vertebral  subluxation  depends  upon  a  thorough  knowledge 
of  the  nervous  system,  the  nerve-supply  to  the  different  parts 
of  the  body,  and  the  function  of  the  nerves  emanating  from 
each  spinal  segment. 

A  ready  familiarity  with  the  pathological  changes  which 
may  occur  in  every  organ  is  also  very  essential,  in  order  that 
the  condition  of  the  part  which  is  improperly  innervated  may 
be  known. 

It  is  impossible  from  the  spinal  analysis  alone  to  make  a 
diagnosis  of  the  nature  of  the  disease.  What  the  spinal 
analysis  determines  is  that  disease  of  a  certain  organ  exists ; 
the  special  examination  of  the  organ  then  establishes  the 
exact  nature  of  the  disease.  For  example,  detection  of  a  sub- 
luxation at  the  fourth  thoracic  segment  determines  the  fact 
that  there  is  disease  of  the  liver,  but  whether  the  disease  is 
cancer  or  congestion  it  is  impossible  to  state ;  only  the  special 
examination  of  the  liver  and  the  general  symptom  complex 
can  determine  this. 

A  thorough  understanding  of  the  above  principle  makes 
the  diagnosis  of  disease  in  certain  parts  of  the  body  extremely 
accurate,  and  the  palpation  of  the  vertebral  column  for  the 
detection  of  subluxations  is  one  of  the  most  valuable  aids  in 
the  making  of  a  correct  diagnosis  that  we  have  at  our  com- 
mand. For  example,  diagnosis  of  conditions  in  the  abdomen 
is  often  very  difficult ;  this  is  true  for  the  reason  that  we  are 
dealing  with  a  number  of  organs,  all  adjacent  to  each  other 
and  the  condition  of  which  is  constantly  changing.  Thus  the 
Stomach  at  one  time  contains  solids,  at  another  liquids,  at 

248 


SPINAL  DIAGNOSIS  249 

another  time  gas ;  a  tumor  in  the  abdomen  may  be  connected 
with  the  Hver,  the  kidney  on  the  right  side,  the  stomach,  the 
ovary,  it  may  be  an  enlarged  mesenteric  gland,  an  enlarged 
spleen,  a  cyst  of  the  omentum,  or  simply  a  mass  of  fecal  mat- 
ter. There  is  no  necessity  for  calling  attention  to  the  fact 
of  the  differing  diagnoses  of  dilYerent  physicians  in  regard  to 
abdominal  conditions,  and  how  often  wrong  diagnoses  are 
made;  often,  alas,  to  the  patient's  detriment.  These  differ- 
ences in  diagnosis  are  very  often  not  alone  in  respect  to  the 
nature  of  the  disease  with  which  a  certain  organ  is  affected, 
but  frequently  differences  of  opinion  exist  as  to  what  organ 
is  affected.  This  is  not  surprising  when  we  consider  that  the 
abdominal  organs  are  loosely  packed  in  the  abdomen,  and 
reliance  must  be  placed  entirely  on  palpation  and  percussion 
in  the  physical  examination  of  the  parts. 

An  enlarged  liver  may  be  confused  with  an  enlargement 
of  the  right  kidney,  an  enlarged  spleen,  a  tumor  of  the 
pyloric  end  of  the  stomach,  or  impaction  of  the  hepatic  flex- 
ure of  the  colon.  By  palpation  of  the  mass  it  is  frequently 
impossible  to  state  with  which  of  these  organs  the  tumor 
is  connected.  Often  percussion  does  not  give  any  assistance, 
since  the  dulness  elicited  by  percussion  is  so  similar  over  all 
the  organs  that  the  slight  shade  of  difference  cannot  be  dis- 
tinguished. By  palpation  of  the  vertebral  column,  and  the 
detection  of  a  subluxation  in  a  certain  segment,  however,  the 
exact  organ  affected  can  be  readily  determined. 

Let  us  carry  the  above  illustration  farther,  and  suppose 
that  a  tumor  mass  is  palpated  in  the  abdomen,  but  by  all 
the  usual  methods  of  examination  it  has  been  impossible  to 
determine  which  of  the  organs  is  affected.  If  the  spine  is  then 
palpated,  the  following  findings  will  establish  which  of  the 
organs  is  affected.  If  the  fourth  thoracic  vertebra  is  sub- 
luxated,  the  tumor  is  in  connection  with  the  liver ;  if  the  fifth, 
sixth,  or  seventh  thoracic  vertebra  is  subluxated,  it  is  con- 
nected with  the  stomach ;  if  the  eighth  thoracic  vertebra  is 
the  one  subluxated,  it  may  be  concluded  that  the  spleen  is 
involved ;  if  the  tenth  thoracic  vertebra  is  subluxated,  the 
kidney  is  the  organ  affected;  if  the  lower  thoracic  or  upper 
lumbar  vertebrae  are  the  seat  of  subluxations,  the  trouble  is 
located  in  the  intestines.     These  findings  are  constant,  that 


250  SPINAL  ADJUSTMENT 

is  to  say,  if  the  disease  is  of  the  liver,  a  subluxation  will  in- 
variably be  found  at  the  fourth  thoracic  vertebra,  and  simi- 
larly of  the  other  viscera  as  outlined  above.  By  such  a 
process  we  are  able  to  determine  exactly  which  organ  is 
affected  in  conditions  affecting  the  abdominal  viscera. 

There  is  one  difficulty  in  the  making  of  a  diagnosis  by 
spinal  analysis.  This  is  the  fact  that  in  a  few  instances  the 
same  nerve  supplies  different  organs,  and  if  this  nerve  alone 
were  impinged  it  would  naturally  be  impossible  to  state  which 
of  these  organs  is  affected,  and  a  consideration  of  the  symp- 
toms and  signs  would  be  necessary.  However,  no  disease 
process  exists  long  in  any  organ  before  reflex  subluxations 
are  produced  in  those  segments  from  which  the  organ  in 
question  derives  its  innervation,  as  explained  fully  in  the 
chapter  on  the  reflex  production  of  mal-alignments  of  vertebra. 
From  these  secondary  subluxations  it  then  becomes  possible 
to  determine  the  organ  which  is  involved.  After  the  specific 
organ  involved  has  been  decided  upon,  the  special  examina- 
tion of  the  organ  and  the  careful  consideration  of  all  symptoms 
and  signs  present,  together  with  chemical  and  microscopical 
analysis  of  urine,  feces,  blood,  gastric  contents,  sputum,  and 
other  methods  of  diagnosis  should  be  used. 

In  the  past  many  practitioners  of  spinal  adjustment  have 
made  the  claim  that  they  were  able  from  the  analysis  of  the 
spine  to  make  an  absolute  diagnosis  of  the  patient's  disease. 
Some  were  honest  in  this  claim,  but  simply  ignorant  of  the 
fact  that  it  is  one  thing  to  know  what  organ  is  affected,  and 
another  how  that  organ  is  affected.  These  persons  had  no 
knowledge  of  pathology.  They  simply  considered  it  suffi- 
cient to  know  what  organ  is  affected,  and  it  possibly  never 
occurred  to  them  to  ascertain  how  that  organ  was  affected. 
Many  who  may  have  thought  of  this  feature  paid  no  further 
attention  to  the  subject,  but  were  content  with  using  spinal 
adjustment  and  considered  it  sufficient  to  know  that  the 
patient  was  cured.  This  is  an  extremely  unscientific  manner  of 
treating  disease,  however,  and  leads  to  many  gross  errors. 
As  a  matter  of  fact,  the  patient  is  usually  himself  aware  before 
he  consults  a  physician  what  organ  is  diseased,  and  wishes 
to  know  how  that  organ  is  affected.  For  example,  a  patient 
complains  of  a  group  of  symptoms  which  point  directly  to 


SPINAL  DIAGNOSIS  251 

disease  of  the  liver;  he  is  however  unable  to  interpret  these 
symptoms  correctly,  and  therefore  unable  to  say  what  the 
nature  of  the  disease  is.  It  is  his  desire  to  know  this  that 
prompts  him  to  consult  a  physician.  Without  an  exact  knowl- 
edge of  the  specific  nature  of  the  disease  the  operator  is  un- 
able to  give  a  correct  prognosis.  Here  some  may  differ  for 
the  claim  is  still  made  by  them  that  all  diseases  are  curable 
by  spinal  adjustment,  and  that,  therefore,  prognosis  is  good  in 
all  cases.  Facts  will  not  bear  out  such  claims,  since  there  are 
still  some  diseases  for  which  no  remedy  has  been  as  yet  dis- 
covered, and  spinal  adjustment  will  not  cure  cancer,  for  in- 
stance. From  a  specific  diagnosis  we  are  therefore  enabled 
to  state  the  exact  nature  of  the  disease  and  give  an  approxi- 
mately accurate  prognosis,  as  well  as  treat  any  of  the  diseased 
conditions  which  so  often  complicate  disease  of  certain  organs. 

The  following  tables  will  assist  the  operator  in  making 
a  diagnosis  as  to  the  organ,  part,  or  system  which  is  affected 
when  vertebral  subluxations  are  found  in  certain  sections 
of  the  vertebral  column : 

The  1st  Cervical  Nerve. — Superior  and  inferior  oblique, 
complexus,  rectus  capitis  posticus  major  and  minor  muscles ; 
skin  of  occiput;  cranium,  brain,  face,  ears,  eyes,  larynx;  chills 
and  fever. 

The  2nd  Cervical  Nerve. — Complexus,  obliquus  inferior, 
semispinalis,  multifidus  spinae  muscles ;  posterior  half  of 
scalp ;  larynx ;  fevers. 

The  3rd  Cervical  Nerve. — Integument  of  the  occiput  and 
posterior  cervical  region ;  eyes,  larynx,  heart,  lungs,  dia- 
phragm ;  fevers. 

The  4th  Cervical  Nerve. — Scaleni,  supraspinatus,  infras- 
pinatus, rhomboidei,  teres  minor  muscles ;  throat,  thyroid 
gland,  eyes,  diaphragm,  heart ;  fevers ;  vasomotor  nerves. 

The  5th  Cervical  Nerve. — Subclavius,  supraspinatus,  in- 
fraspinatus, subscapularis,  teres  major  and  minor,  deltoid, 
brachialis  anticus,  biceps,  serratus  magnus,  pectoralis  major 
and  minor,  flexor  sublimis  digitorum,  lumbricales  muscles; 
eye,  heart,  thyroid  gland,  throat ;  fevers ;  smallpox. 

The  6th  Cervical  Nerve. — Subclavius,  supraspinatus,  in- 
fraspinatus, subscapularis,  teres  major  and  minor,  deltoid, 
brachialis  anticus,  biceps,  pronator  teres,  pronator  quadratus, 


252 


SPINAL  ADJUSTMENT 


e    C.Ut,3 


Fig.  41. 

Segmentation  Chart. 


SPINAL  DIAGNOSIS  253 

latissimus  dorsi,  pectoralis  major  and  minor,  serratus  magnus, 
triceps,  supinator  longus  and  brevis,  flexor  carpi  radialis, 
palmaris  longus,  extensor  carpi  radialis  longior  and  brevior, 
abductor  pollicis,  opponens  pollicis,  flexor  pollicis  muscles ; 
eyes,  ears,  throat,  thyroid  gland ;  chills  and  fever. 

The  7th  Cervical  Nerve. — Extensor  carpi  radialis  longior 
and  brevior,  opponens  pollicis,  flexor  pollicis,  abductor  pollicis, 
serratus  magnus,  coraco-brachialis,  extensor  communis  digi- 
torum,  extensor  pollicis  longus  and  brevis,  extensor  carpi 
ulnaris,  abductor  indicis,  abductor  minimi  digiti,  extensor 
indicis,  extensor  minimi  digiti,  latissimus  dorsi,  triceps, 
anconeus,  pectoralis  major;  brain. 

The  8th  Cervical  Nerve. — Latissimus  dorsi,  triceps,  an- 
coneus, pectoralis  major  and  minor,  flexor  carpi  ulnaris,  flexor 
profundus  digitorum,  flexor  longus  pollicis,  pronator  quad- 
ratus,  flexor  sublimis  digitorum,  lumbricales,  interossei, 
abductor  pollicis,  flexor  brevis  pollicis  muscles. 

The  1st  Thoracic  Nerve. — Pronator  quadratus,  flexor  car- 
pi ulnaris,  flexor  longus  pollicis,  flexor  profundus  digitorum, 
intrinsic  muscles  of  hand,  pupillary  fibres ;  eye,  heart, 
pericardium,  lungs,  pleura,  liver,  integument  of  the  body. 

The  2nd  Thoracic  Nerve. — Intercostal  muscles ;  vasomotor 
nerves ;  disorders  of  the  arm ;  heart ;  fevers ;  bronchi ; 
mediastinum. 

The  3rd  Thoracic  Nerve. — Intercostal  muscles ;  heart, 
lungs  and  pleura ;  liver ;  eye ;  integument  of  body. 

The  4th  Thoracic  Nerve. — Intercostal  muscles ;  heart,  lungs 
and  pleura. 

The  5th  Thoracic  Nerve. — Intercostal  muscles;  breasts, 
pleura,  liver,  constitutional  diseases,  stomach,  spleen. 

The  6th  Thoracic  Nerve. — Intercostal  muscles ;  stomach, 
spleen. 

The  7th  Thoracic  Nerve. — Intercostal  and  abdominal 
muscles;  stomach,  spleen,  gall  bladder. 

The  8th  Thoracic  Nerve. — Intercostal  and  abdominal  mus- 
cles; stomach,  spleen,  gall  bladder,  cystic  duct,  pancreas; 
chills  and  fever. 

The  9th  Thoracic  Nerve. — Intercostal  and  abdominal  mus- 
cles;  gall  bladder,  spleen,  pancreas,  stomach,  cystic  duct; 
chills  and  fever. 


254  SPINAL  ADJUSTMENT 

The  10th  Thoracic  Nerve. — Intercostal  and  abdominal 
muscles ;  pancreas,  spleen,  cystic  duct,  diaphragm,  kidneys 
and  ureters. 

The  11th  Thoracic  Nerve. — Abdominal  muscles;  dia- 
phragm, pancreas,  kidneys,  bladder,  intestines. 

The  12th  Thoracic  Nerve. — Abdominal  muscles;  dia- 
phragm, kidneys  and  ureters,  large  and  small  intestines,  ver- 
miform appendix,  uterus,  prostate  gland,  testes,  ovaries, 
epididymis,  spermatic  cord,  penis. 

The  1st  Lumbar  Nerve. — Quadratus  lumborum  muscle; 
large  and  small  intestines,  vermiform  appendix,  uterus,  ova- 
ries, Fallopian  tubes,  testes,  spermatic  cord,  epididymis,  penis, 
bladder;  muscles  of  the  lower  extremities. 

The  2nd  Lumbar  Nerve. — Cremaster  and  muscles  of  lower 
extremity ;  intestines,  vermiform  appendix,  uterus,  ovaries. 
Fallopian  tubes,  testes,  epididymis,  penis,  spermatic  cord ; 
fevers. 

The  3rd  Lumbar  Nerve. — Gracilis,  adductor  longus  and 
brevis,  quadriceps  femoris,  obturator  externus,  uterus,  ovaries, 
Fallopian  tubes,  prostate  gland,  spermatic  cord,  epididymis, 
testes,  penis,  bladder. 

The  4th  Lumbar  Nerve. — Gracilis,  abductor  longus  and 
brevis,  quadriceps  femoris,  obturator  externus,  gluteus  medius 
and  minimus,  tensor  fasciae  femoris,  semimembranosus,  pop- 
liteus,  plantaris,  quadratus  femoris,  gemellus  inferior,  crureus 
muscles;  rectum,  anus. 

The  5th  Lumbar  Nerve. — Adductor  longus,  gluteus  maxi- 
mus,  medius  and  minimus,  tensor  fasciae  femoris,  semimem- 
branosus, quadratus  femoris,  popliteus,  plantaris,  gemellus 
superior  and  inferior,  flexor  longus  digitorum,  tibialis  posticus, 
flexor  brevis  digitorum,  flexor  brevis  hallucis,  abductor 
hallucis,  obturator  internus,  semitendinosus,  soleus,  flexor 
longus  hallucis  muscles;  bladder,  prostate  gland,  rectum  and 
anus. 

The  1st  Sacral  Nerve. — Gluteus  maximus,  medius  and  min- 
imus, semimembranosus,  semitendinosus,  quadratus  femoris, 
superior  and  inferior  gemellus,  tensor  fasciae  femoris,  pop- 
liteus, plantaris,  flexor  longus  digitorum,  flexor  brevis  digi- 
torum, flexor  longus  hallucis,  flexor  brevis  hallucis,  abductor 
hallucis,  biceps  femoris,  obturator  internus,  soleus,  pyriformis, 


SPINAL  DIAGNOSIS  255 

abductor  minimi  digiti,  abductor,  transversus  and  obliquus 
hallucis,  interossei  muscles. 

The  2nd  Sacral  Nerve. — Gemellus  superior,  obturator  in- 
ternus,  gluteus  maximus,  semitendinosus,  soleus,  flexo.r  longus 
hallucis,  pyriformis,  gastrocnemius,  abductor  minimi  digiti, 
abductor,  transversus  and  obliquus  hallucis,  biceps  femoris 
muscles. 

The  3rd  Sacral  Nerve. — Center  for  erection  and  ejaculation. 

The  4th  Sacral  Nerve. — Center  for  sphincters  of  anus  and 
bladder. 


CHAPTER  IV 

Vertebral  Subluxations 

As  has  been  already  stated,  vertebral  subluxations  have 
l)een  very  little  studied  by  the  medical  profession.  The  med- 
ical student  does  not  make  a  dissection  of  the  vertebral  col- 
umn, and  therefore  has  only  a  general  conception  of  this 
portion  of  the  body.  The  average  medical  practitioner  knows 
that  a  vertebra  is  composed  of  a  body,  an  arch,  intervertebral 
cartilages,  and  articular  processes ;  he  may  be  somewhat 
familiar  with  the  ligaments  of  the  spine,  at  least  to  the  extent 
of  holding  to  the  erroneous  view  that  they  prevent  under  any 
and  all  circumstances  the  possibility  of  displacement  of  the 
vertebrae.  Anatomists  have  taught  for  centuries  that  dis- 
placements of  the  vertebrae  are  a  practical  impossibility  in 
the  absence  of  fracture,  and  all  who  have  followed  in  their 
wake  have  accepted  these  views  as  final,  and  made  no  personal 
investigations  which  might  have  changed  these  opinions. 

The  fact  that  slight  displacements  of  the  vertebrae  not 
amounting  to  actual  dislocations  are  possible  in  the  spine 
has  never  been  investigated,  and  these  minor  lesions  of  the 
vertebral  column  have  therefore  been  left  unrecognized  until 
recent  years.  The  greatest  reason  for  the  tardy  acceptance 
of  subluxations  as  a  fact  has  been  the  firm  adherence  to  the 
above  views,  and  an  entire  unwillingness  on  the  part  of  the 
profession  to  even  consider  the  subject.  This  has  been  partly 
due  to  the  fact  that  these  views  were  originally  put  forth  by 
men  of  very  limited  education  along  kindred  lines,  and  who, 
while  their  basic  principles  were  correct,  made  other  erroneous 
statements  in  connection  therewith,  which  naturally  pre- 
cluded the  possibility  of  any  recognition  of  their  views  by 
men  versed  in  the  science  of  disease.  It  is  possible  that  had 
these  same  views  been  advanced  originally  by  men  of  superior 
intelligence  and  attainments,  speedy  recognition  of  vertebral 
subluxations  as  a  possibility  and  a  factor  in  the  production  of 
disease  would  have  been  accorded  them. 

256 


VERTEBRAL  SUBLUXATIONS  257 

In  the  author's  mind,  therefore,  it  has  been  due  to  the 
failure  of  the  medical  profession  to  give  the  slightest  atten- 
tion to  this  field  of  thought,  instead  of  giving  it  some  con- 
sideration, that  has  resulted  in  constant  denials  of  the  possi- 
bility of  subluxation  of  the  vertebrae.  Men  who  have  not 
spent  one  moment's  serious  consideration  of  the  subject  of 
spinal  adjustment  deny  that  there  is  any  truth  or  logic 
in  the  claims  made  by  its  advocates.  On  the  contrary,  those 
who  do  investigate  the  subject  and  give  it  serious  thought 
and  study,  become  convinced  of  the  soundness  of  its  theoretical 
basis. 

The  general  opinion  has  been  that  by  the  term  "subluxa- 
tion" a  dislocation  is  implied.  Such  a  construction  of  this 
term  is,  however,  erroneous,  since  it  does  not  imply  a  com- 
plete disarticulation.  It  is  freely  admitted  that  a  dislocation 
of  a  vertebra  without  fracture  is  hardly  possible.  But 
chiropractic  does  not  claim  to  deal  with  dislocations  of  the 
vertebrae.  When  the  word  subluxation  is  used,  it  is  meajit 
to  convey  the  fact  that  a  slight  change  in  the  relative  position 
of  a  vertebra  to  the  contiguous  surfaces  of  the  vertebra  above 
and  the  one  below  it  has  occurred.  That  is  to  say,  instead 
of  the  entire  surface  area  of  a  vertebra  being  approximated, 
with  die-like  precision  and  accuracy,  to  its  fellows  above  and 
below  it,  it  is  slightly  shifted  from  this  position.  There  has 
simply  been  a  shifting  in  the  position  of  one  vertebra  upon 
another,  and  the  greater  portion  of  the  surface  area  of  the 
two  vertebrae  still  oppose  each  other.  This  movement  is  in 
various  directions  depending  upon  the  configuration  of  the 
articular  processes  of  the  vertebrae  involved,  upon  the  direc- 
tion of  any  external  forces  which  may  have  produced  it,  or 
upon  the  nature  of  the  ligamentous  contraction  which  has 
operated  to  draw  the  vertebra  out  of  alignment.  It  is  these 
various  forms  of  displacements  which  we  will  consider  in 
this  chapter. 

We  have  considered  vertebral  subluxations  from  their 
anatomical  basis,  from  their  etiological  basis,  and  from  their 
effects.  Let  us  now  study  the  physical  changes  which  actu- 
ally occur  when  a  subluxation  takes  place,  and  which  tend 
to  make  it  possible.  In  the  first  place  it  must  constantly  be 
borne  in  mind  that  a  certain  change  occurs  in  the  ligamentous 


258  SPINAL  ADJUSTMENT 

structures  surrounding  the  vertebra  which  is  subluxated, 
and  also  in  the  intervertebral  cartilaginous  disc.  Without 
these  changes  subluxations  are  impossible.  The  vertebra 
must  be  looked  upon  as  it  is  in  situ,  and  not  as  it  would  be, 
disarticulated  from  the  balance  of  the  spine,  devoid  of  liga- 
ments and  of  the  cartilaginous  disc.  The  failure  to 
thus  view  the  vertebra  is  what  produces  the  opinion  held 
even  today  by  some  chiropractors  that  the  vertebra  slips  out 
of  place  in  a  certain  direction,  and  an  adjustment  pushes 
it  back  into  its  proper  position.  These  operators  have  failed 
to  recognize  the  physical  factors  entering  into  the  production 
of  spinal  subluxations  and  their  correction  by  the  thrust  ap- 
plied to  the  vertebrae.  What  really  produces  a  subluxation 
is  its  displacement  beyond  a  certain  limit ;  and  what  reduces 
the  subluxation  is  the  forcing  back  of  the  vertebra  to  its 
normal  position. 

That  property  of  ligaments  and  cartilage  by  which  they 
possess  their  function  of  holding  parts  in  position,  and  per- 
mitting of  a  certain  degree  of  movement  between  these  parts, 
is  their  elasticity.  Were  the  ligaments  of  the  vertebrae  rigid 
bands  instead  of  elastic  fibres,  and  were  the  intervertebral 
cartilages  solid  plates  instead  of  elastic  discs,  not  the  slightest 
movement  between  the  various  vertebrae  would  be  possible. 
However,  they  are  elastic,  and  it  is  the  measure  of  their  elas- 
ticity which  determines  the  degree  of  movement  which  is  pos- 
sible between  the  vertebrae  which  they  hold  in  apposition. 
When  the  limit  of  their  elasticity  is  overcome  and  the  force 
which  is  responsible  for  this  is  continued,  they  do  not  return 
to  their  former  state  when  the  force  is  finally  removed,  and 
the  vertebrae  remain  in  this  position  because  the  elastic  limit 
of  their  ligaments  and  of  the  cartilages  has  been  passed. 

"The  elastic  limit  of  any  material  is  defined  as  the  point 
at  which,  under  applied  loads,  the  stresses  are  no  longer  pro- 
portional to  the  loads.  Beyond  the  elastic  limit  of  a  material 
the  deformation  is  no  longer  proportional  to  the  applied  forces, 
and  upon  removal  of  the  forces,  the  material  will  not  return 
to  its  original  condition,  but  maintains  a  permanent  set." 
(Dana.)  When,  therefore,  the  ligaments  of  one  side  of  the 
vertebrae  are  contracted  and  acting  as  a  force  which  draws 
the  vertebra   toward  the   side  on   which   they   are   situated, 


VERTEBRAL  SUBLUXATIONS  259 

the  ligaments  of  the  other  side  are  stretched ;  if  this  stretching 
is  beyond  the  limit  of  their  elasticity,  they  will  not  return  to 
their  former  position  when  the  force  is  removed,  but  become 
set.  The  contracted  ligament  remains  in  its  contracted  con- 
dition, and  the  vertebra  is  permanently  drawn  toward  the 
contracted  side. 

The  same  principles  apply  to  the  intervertebral  cartilages. 
If  these  structures  are  compressed  beyond  their  limit  of 
elasticity,  they  fail  to  resume  their  former  shape  when  the 
force  is  removed,  but  remain  set.  If,  for  example,  one  side 
of  a  cartilaginous  disc  is  so  compressed,  it  fails  to  return  to 
its  former  thickness  and  remains  permanently  thinned.  In 
this  manner  are  produced  the  various  forms  of  compression 
subluxation  which  result  in  a  movement  toward  each  other 
on  the  vertebrae  between  which  the  disc  is  thinned,  and 
which  produces  a  narrowing  of  the  intervertebral  foramen. 
This  thinning  of  a  disc  may  be  on  either  side,  at  its  anterior 
or  its  posterior  aspect.  An  evenly  distributed  compression 
of  the  entire  disc  beyond  its  limit  of  elasticity  will  result  in 
an  approximation  of  the  vertebra  above  and  the  one  below  it, 
resulting  in  a  narrowing  of  the  intervertebral  foramen  on  each 
side. 

Besides  compression  of  the  discs  as  a  result  of  applied 
forces,  there  is  shearing  or  slipping.  When  pressure  is 
brought  to  bear  upon  the  two  surfaces  of  an  intervertebral 
disc,  there  may  be  a  sidewise  movement  of  the  vertebra 
above  or  below  it.  This  is  a  result  of  the  shearing  of  the 
disc  and  an  actual  displacement  can  only  be  produced  by 
such  shearing  of  the  intervertebral  cartilaginous  disc.  The 
displacement  of  the  vertebra  may  be  to  the  right  or  the  left, 
and  anteriorly  or  posteriorly. 

Finally  there  is  one  other  force  acting  through  the  spine, 
namely  rotation  or  turning.  That  the  vertebrae  normally 
turn  upon  their  axis  with  reference  to  each  other  we  know 
to  be  a  fact,  as  is  witnessed  in  the  lumbar  region  of  the 
spine  when  the  head  and  trunk  are  turned  with  respect  to 
the  hips,  and  each  vertebra  twists  slightly  upon  its  fellow. 
This  turning  movement  produces  a  tension  upon  the  liga- 
ments on  one  side  of  the  vertebra,  and  causes  a  change  in  the 
form  of  the  intervertebral  cartilaginous  disc.     If  this  turning 


260  SPINAL  ADJUSTMENT 

movement  should  become  extreme,  and  exceed  the  point  of 
limit  of  elasticity  of  the  ligaments  and  the  disc,  these  struc- 
tures will  fail  to  return  to  their  former  state,  and  the  vertebra 
remains  set  in  that  twisted  or  turned  position ;  in  other  words, 
it  remains  rotated  upon  its  axis. 

These  various  forms  of  displacement  of  the  vertebrae  do 
not  occur  in  all  regions  of  the  spine,  for  the  reason  that  the 
conformation  of  the  articular  processes  in  the  different  types 
of  vertebrae  will  prevent  movement  of  the  vertebrae  in  some 
directions,  while  it  favors  movement  in  certain  other  direc- 
tions. We  thus  find  certain  forms  of  displacements  peculiar 
to  certain  sections  of  the  vertebral  column. 

The  next  factor  which  has  a  bearing  upon  the  nature  of 
the  subluxation  in  any  section  of  the  spine  is  the  kind  and 
the  direction  of  the  applied  force.  In  subluxations  produced 
reflexly  the  ligamentous  contraction  is  most  pronounced  on 
one  side,  and  consequently  the  corresponding  side  of  the  disc 
will  be  thinned  or  compressed,  or  shearing  results  and  the 
vertebra  is  drawn  to  that  side. 

The  various  forms  of  subluxations  which  occur  in  the 
vertebral  column  in  the  manner  above  described  may  there- 
fore be  enumerated  as  follows : 

Kyphotic.  Lateral. 

Lordotic.  Anterior. 

Scoliotic,  Posterior. 

Compression.  Rotary. 
Supero-Inferior. 

In  addition  to  the  above  which  may  be  termed  simple 
subluxations,  there  may  be  found  combinations  of  two  simple 
displacements,  constituting  compound  subluxations.  These 
are  as  follows : 

Postero-Lateral.  Antero-Rotary. 

Antero-Lateral.  Antero-Supero-Inferior. 

Postero-Rotary.  Postero-Supero-Inferior. 

Kyphotic  Subluxation. — Kyphosis  is  a  backward  bending, 
of  a  section  of  the  spine.  This  form  of  subluxation  usually 
is  not  confined  to  a  single  vertebra  but  ordinarily  involves  a 


VERTEBRAL  SUBLUXATIONS  261 

group  of  vertebrae,  and  is  seen  in  connection  with  Pott's 
disease.  A  true  kyphotic  subluxation  is  produced  by  a 
change  in  the  intervertebral  cartilaginous  disc,  whereby  its 
anterior  portion  becomes  thinned,  as  a  result  of  some  de- 
structive process,  and  the  vertebrae  are  thus  permitted  to 
approach  each  other  at  their  anterior  aspect.  This  in  reality 
is  a  compression  subluxation,  and  would  be  so  classed  were 
the  above  condition  confined  to  a  single  vertebra.  This 
is,  however,  rarely  the  case,  for  the  disease  process  which 
causes  the  thinning  of  the  disc  does  not  confine  itself,  as  a 
rule,  to  one  segment  but  involves  several  vertcl  rae  before 
its  progress,  is  arrested. 

In  this  form  of  subluxation  the  superior  articular  processes 
usually  remain  in  their  normal  position,  unless  a  group  of 
vertebrae  are  involved,  in  which  case  there  will  be  more  or 
less  displacement  of  both  the  superior  and  inferior  articular 
processes.  The  spinous  processes  are  thrown  apart  as  a 
result  of  the  separation  of  the  posterior  portion  of  each  ver- 
tebra as  the  anterior  portion  of  each  vertebra  more  and  more 
approaches  that  of  its  fellows.  A  similar  condition  of  sepa- 
ration of  the  spinous  processes  might  also  occur  as  a  result 
of  a  thickening  of  the  posterior  portion  of  the  discs  without 
any  change  in  the  thickness  of  their  anterior  portion,  and 
produce  a  separation  of  the  articular  processes.  Such  a  con- 
dition will  not,  however,  produce  an  impingement  of  the  ves- 
sels and  nerves  passing  through  the  intervertebral  foramina, 
since  their  diameter  remains  unchanged.  This  form  of  sub- 
luxation is  therefore  of  no  importance  from  the  standpoint  of 
producing  disease,  but  deformities  of  this  nature  should  be 
corrected,  since  they  cause  a  narrowing  of  the  thorax  and 
are  thus  apt  to  lead  to  pulmonary  diseases.  Such  deformi- 
ties are  the  usual  condition  which  is  present  in  cases  of 
"Round  Shoulders,"  and  the  thickening  of  the  posterior  por- 
tion of  the  disc  is  due  to  the  constant  stretching  of  its  pos- 
terior fibres  by  the  habit  of  bending  forward,  which  results 
in  a  species  of  hypertrophy  of  that  portion  of  the  disc. 

In  true  kyphotic  subluxations  the  vertical  diameter  of  the 
intervertebral  foramen  is  increased,  while  its  antero-posterior 
diameter  is  diminished  as  a  result  of  being  encroached  upon 
by    the    inferior   articular    processes    of    each    vertebra,    and 


262  SPINAL  ADJUSTMENT 

also  by  the  protrusion   of  the  posterior  portion   of  the  disc 
into  it. 

The  kyphotic  subluxations  are  seen  most  commonly  in  the 
dorsal  region  of  the  spine;  very  much  less  commonly  in  the 
lumbar  region ;  never  in  the  cervical  region,  unless  a  destruc- 
tive process  resulting  from  syphilis  or  tuberculosis  has 
destroyed  a  portion  of  these  vertebrae.     Fig.  42. 


Kyphotic  Subluxation. 

Lordotic  Subluxation.— Lordosis  is  a  forward  bending  of 
a  section  of  the  spine,  and  is  the  opposite  to  kyphosis.  Like 
kyphosis,  lordosis  is  not  limited  to  a  single  vertebra,  but 
usually  involves  a  group  of  vertebrae.  A  lordotic  subluxa- 
tion is  produced  by  a  thinning  of  the  posterior  portion  of 
the  intervertebral  cartilaginous  discs,  and  this  permits  the 
involved  vertebrae  to  approach  each  other  at  their  posterior 
aspect.  The  lordotic  subluxation  is  almost  invariably  asso- 
ciated with  some  other  form  of  displacement,  usually  a  pos- 
terior, being  in  reality  a  posterior  compression  subluxation, 


VERTEBRAL  SUBLUXA'IIONS  263 

since  the  posterior  part  of  the  intervertebral  disc  is  com- 
pressed. It  is  not,  however,  classed  as  a  compression  sublux- 
ation since  the  process  is  not  confined  to  a  single  vertebra, 
but  affects  a  number  of  vertebrae. 

In  this  form  of  subluxation  the  inferior  articular  processes 
are  displaced  posteriorly,  while  the  superior  articular  processes 
of  the  vertebrae  below  encroach  on  the  intervertebral  fora- 
men. As  a  result  of  the  thinning  of  the  posterior  portion  of 
the  discs  the  vertebrae  approach  each  other  posteriorly,  and 
thus  the  spinous  processes  are  thrown  together. 

Primary  lordosis  affects  most  pronouncedly  the  thoracic 
region  of  the  vertebral  column,  and  is  most  noticeable  in  that 
region  of  the  spine,  for  the  reason  that  normally  there  is  a 
backward  curvature  of  the  spine  here,  while  in  the  lumbar 
and  cervical  region  the  back  normally  curves  forward. 
Lordosis,  however,  is  usually  met  with  as  a  result  of  a  kypho- 
tic subluxation,  and  since  this  form  occurs  most  commonly 
in  the  thoracic  region,  lordosis  is  seen  most  often  in  the 
cervical  and  lumbar  regions  of  the  spine.  The  untoward 
effects  of  kyphosis  must  therefore  be  looked  for  in  its  asso- 
ciated lordotic  displacements,  as  the  loose  capsular  ligaments 
permit  a  forward  movement  of  the  superior  articular  processes 
of  the  involved  vertebrae.  A  study  of  the  placement  of  the 
articular  processes  of  two  vertebrae  with  reference  to  each 
other,  with  the  spine  in  the  vertical  position,  will  show  how 
easily  such  a  condition  may  be  produced ;  placing  the  spine 
in  a  horizontal  plane,  and  again  studying  the  placement  of 
the  articular  processes  will  show  how  impossible  it  would 
be  to  cause  any  shifting  of  the  vertebrae  upon  each  other 
in  this  position.  When  the  superimposed  weight  of  the  body 
is  placed  largely  on  the  bodies  of  the  vertebrae,  the  inferior 
processes  of  the  vertebrae  are  brought  firmly  up  against  the 
superior  articular  processes  of  the  vertebrae  below  them,  and 
no  displacement  can  occur.  If,  however,  the  head  and  chest 
are  thrown  too  far  backward,  and  the  weight  is  thrown  upon 
the  articular  processes,  the  inferior  articular  processes  will 
have  a  tendency  to  slide  backward  on  the  superior  articular 
processes  of  the  vertebra  below,  and  in  this  way  will  force 
the  latter  forward  into  the  intervertebral  foramen.  A  careful 
study  of  Fig.  43  will  show  that  this  is  mechanically  correct. 


264 


SPINAL  ADJUSTMENT 


In  a  lordotic  subluxation  the  intervertebral  foramen  is  in- 
creased in  size  vertically,  but  its  antero-posterior  diameter  is 
diminished  and  the  vessels  and  nerves  which  it  transmits  com- 
pressed by  being  encroached  upon  by  the  superior  articular 
processes.     Fig.  43. 

Scoliotic  Subluxation. — Scoliosis  is  a  lateral  curvature  of 
a  section  of  the  vertebral  column,  or  of  the  entire  column. 
True  scoliosis  is  also  not  confined  to  a  single  vertebra,  but  in- 


Fig.  43. 

Lordotic  Subluxation. 

volves  at  least  three  vertebrae.  What  might  be  termed  a 
physiological  scoliosis  is  commonly  seen  in  individuals  who 
use  the  right  arm  almost  exclusively  in  their  work,  and  as  a 
result  of  the  muscular  contraction  on  the  right  side  the 
spine  is  slightly  drawn  toward  that  side. 

This  form  of  subluxation  is  due  to  a  thinning  of  the  lateral 
aspect  of  the  intervertebral  cartilaginous  discs,  which  per- 
mits the  sides  of  the  bodies  of  a  group  of  vertebrae  to  ap- 
proach each  other.  As  a  result  of  this  lateral  approximation  of 
the  vertebrae  the  transverse  processes  on  the  contracted  side 


VERTEBRAL  SUBLUXATIONS 


265 


are  brought  toward  each  other  on  that  side,  while  on  the  op- 
posite side  they  are  widely  separated.  This  results  in  a 
marked  diminution  in  the  vertical  diameter  of  the  interverte- 
bral foramina  on  the  compressed  side.  The  spinous  processes 
of  the  involved  vertebrae  are  displaced  laterally. 

Scoliosis  is  seen  in  the  cervical  region  of  the  spine  in 
cases  of  wry-neck.  It  is,  however,  met  with  most  commonly 
in  the  thoracic  region.     When  the  degree  of  scoliosis  is  very 


Fig.  44. 

Scoliotic   Subluxatiou. 

marked,  a  compensation  curve  in  the  cervical  or  lumbar 
region  is  produced,  which  gives  the  vertebral  column  the 
appearance  of  the  capital  letter  S.     Fig.  44. 

Compression  Subluxation. — This  form  of  subluxation  is, 
as  its  name  implies,  one  in  which  the  cartilaginous  disc  be- 
tween two  vertebrae  is  thinned.  This  diminution  in  the  thick- 
ness of  the  disc  permits  the  vertebra  which  rests  upon  it  to 
approach  the  vertebra  below  it,  and  «  produce  a  decrease 
in  the  vertical  diameter  of  the  intervertebral  foramina  between 
them. 


266  SPINAL  ADJUSTMENT 

The  thinning  of  the  disc  is  produced  by  interference  with 
its  nutrition  as  a  result  of  a  contracted  condition  of  the  liga- 
ments on  both  sides  of  the  vertebrae  which  is  brought  about 
by  reflex  impulses  from  some  diseased  part  of  the  body.  The 
disc  is  thus  affected  not  alone  by  the  pressure  thus  occasioned, 
but  also  by  reason  of  the  interference  with  its  nerve-supply 
as  a  result  of  the  narrowing  of  the  vertical  diameter  of  the 
intervertebral  foramen. 

A  degenerative  process,  as  a  result  of  a  syphilitic  or  tuber- 
cular infection  could  also  produce  a  destruction  of  the  disc ; 
these  disease  processes,  however,  also  invade  the  bone,  and 
more  especially  the  anterior  or  more  cancellous  portion,  and 
would  also  not  be  limited  to  a  single  vertebra,  but  involve 
a  group,  in  which  case  there  would  be  one  of  the  forms  of 
subluxation  above  described. 

A  compression  subluxation  involves  only  one  segment  of 
the  spine,  and  is  ordinarily  a  result  of  a  previous  displacement 
of  a  vertebra  as  pointed  out  above,  and  which  condition  it 
tends  to  make  permanent.  It  also  usually  accompanies  a 
posterior  subluxation,  as  a  result  of  the  interference  with  its 
nutrition  which  results  from  the  compression  of  the  vessels 
in  that  form  of  subluxation.  This  variety  of  subluxation  must 
therefore  be  considered  as  a  complication  of  compression  or 
posterior  subluxations,  the  gravity  of  both  being  much 
increased  by  this  complication. 

In  a  true  compression  subluxation  the  vertical  diameter 
of  the  intervertebral  foramen  on  each  side  is  diminished, 
and  the  opening  is  sufficiently  occluded  to  permit  of  impinge- 
ment of  the  nerves  transmitted  by  them.  As  the  disc  be- 
comes more  and  more  thinned,  the  body  and  pedicles  of  the 
vertebrae  approach  each  other  more  closely.  The  inferior 
articular  processes  of  the  vertebra  above  the  thinned  disc 
glide  downward  on  the  superior  articular  processes  of  the 
vertebra  below,  and  as  they  do  so,  force  the  latter  forward 
into  the  intervertebral  foramina  on  each  side.  The  degree 
of  closure  of  the  foramina  will  of  necessity  depend  upon  the 
extent  of  thinning  of  the  disc,  and  will  be  extreme  if  the 
entire  thickness  of  the  disc  has  been  destroyed.  If  complete 
destruction  takes  place  so  that  the  bodies  of  the  two  verte- 
brae  are   in    direct   apposition,   ankylosis   will   develop   as    it 


VERTEBRAL  SUBLUXATIONS 


267 


would  in  any  joint  in  the  body.  Before  this  takes  place,  how- 
ever, nature  produces  a  forward  bending  of  the  spine  in  the 
affected  region  to  prevent  complete  occlusion  of  the  inter- 
vertebral foramina,  just  as  occurs  in  old  age  when  settling 
of  the  spine  commences,  and  which  is  a  counterpart  of  a 
compression  subluxation,  except  that  all  the  vertebrae  are 
affected  in  the  settling  incident  to  old  age. 

Compression  subluxations  are  met  with  in  all  regions  of 
the  spinal  column.     They  are  least  noticeable  in  the  cervical 


Fig.  45. 
Compression  Subluxation. 

region,  for  the  reason  that  here  the  intervertebral  discs  are 
normally  not  very  thick;  in  the  lumbar  region  they  are  most 
pronounced  since  here  the  di-scs  are  very  thick  in  comparison 
to  those  of  the  other  regions.     Fig.  45. 

Supero-Inferior  Subluxation. — This  form  of  subluxation 
is  a  counterpart  of  the  scoliotic  subluxation,  with  this  excep- 
tion, namely,  that  in  scoliosis  a  group  of  vertebrae  are  in- 
volved, while  in  a  supero-inferior  subluxation  only  one 
vertebra  is  affected.    That  is  to  say,  in  scoliosis  several  discs 


268  SPINAL  ADJUSTMENT 

are  compressed  laterally,  whereas  in  a  siipero-inferior 
subluxation  only  one  disc  is  so  compressed. 

As  a  result  of  the  thinning  of  one  of  the  discs  at  its 
lateral  aspect,  the  vertebra  which  rests  upon  that  disc  ap- 
proaches its  fellow  on  that  side,  bringing  the  transverse 
processes  close  to  each  other ;  on  the  other  side  the  disc 
retains  its  normal  thickness,  or  is  even  thicker  than  normal, 
owing  to  the  separation  which  ensues  upon  that  side  as  a 
result  of  the  compression  on  the  other  side,  and  the  transverse 
processes  are  farther  apart  than  normal. 

The  intervertebral  foramen  on  the  compressed  side  will 
be  much  decreased  in  size  vertically,  while  on  the  opposite 
side  the  foramen  is  enlarged.  The  impingement  or  the  ves- 
sels and  nerves  thus  occasioned  will  produce  serious  conse- 
quences. The  innervation  to  the  parts  supplied  by  the 
afifected  segment  of  the  cord  will  be  interfered  with  as  a 
result  of  the  compression  of  the  spinal  nerve  as  it  passes 
through  the  foramen.  The  compression  of  the  arteries  and 
veins  passing  through  the  foramen  will  produce  congestion 
and  irritability  of  the  segment  of  the  spinal  cord,  and  also 
interfere  with  its  nutrition,  so  that  the  normal  reflex  acts 
which  take  place  there  under  normal  conditions  do  not  now 
occur. 

If  the  supero-inferior  subluxation  is  situated  in  the  cerv- 
ical region  there  will  be  in  addition  to  the  impingement  of 
the  spinal  nerves  compression  of  the  vertebral  arteries.  The 
costo-transverse  processes  are  displaced  downward  and  press 
upon  the  vertebral  artery  below,  which  results  in  a  mutiplicity 
of  cranial  disturbances  due  to  the  vasomotor  efifects,  since  the 
vertebral  arteries  afford  part  of  the  blood  supply  to  the  brain. 

The  supero-inferior  subluxation  is  produced  as  a  result 
of  a  contraction  of  the  ligaments  on  one  side  of  the  vertebrae, 
which  produces  an  approximation  of  the  vertebrae  of  the  cor- 
responding segment.  This  contracted  condition  of  the  liga- 
ments is  occasioned  by  excessive  impulses  from  a  diseased 
portion  of  the  body,  which  reflexly  produce  excessive  outgoing 
impulses  causing  a  contraction  of  the  spinal  ligaments  of 
the  segment  at  which  the  ingoing  impulses  entered.  As  will 
be  remembered,  it  was  stated  in  the  consideration  of  the 
reflex  production  of  subluxations  that  the  efferent  impulse 


VERTEBRAL  SUBLUXATIONS 


269 


of  a  reflex  act  affects  principally  the  muscles  of  the  same 
side  on  which  the  aft'erent  impulse  entered  the  cord;  conse- 
quently the  spinal  muscles'  and  ligaments  on  one  side  will 
ije  contracted,  which  will  compress  the  disc  on  that  side;  if 
this  compression  is  carried  beyond  the  limit  of  elasticity  of 
the  gfisc,  a  permanent  thinning  will  be  produced. 

^his  form  of  subluxation  may  also  be  a  result  of  direct 
traumatism,  and  the  fact  that  the  spinous  and  transverse 
process  on  one  side  are  out  of  alignment  is  positive  evidence 
that  the  centrum  or  body  of  the  displaced  vertebra  is  also 
moved  downward  on  the  compressed  side.     Fig.  46. 


Fig.  i6. 
Supero-Inferior  Subluxation. 


Lateral  Subluxation. — A  lateral  subluxation  is  one  in 
which  a  vertebra  is  displaced  to  either  the  right  or  left.  In 
a  true  lateral  subluxation  there  is  no  twisting,  turning,  or 
tilting  of  the  affected  vertebra.  There  may,  however,  be  an 
apparent  lateral  deviation  of  a  vertebra.  Such  a  condition 
is  produced  by  a  unilateral  contraction  of  the  ligaments  and 
muscles  of  two  vertebrae,  which,  by  drawing  the  vertebra 
toward  that  side  as  a  result  of  compression  of  the  disc,  would 
simulate  a  direct  lateral  deviation  of  the  vertebra  involved. 
Such  a  condition   could,  however,  be   differentiated   from   a 


270  SPINAL  ADJUSTMENT 

true  lateral  subluxation  by  the  fact  that  in  the  former  the 
transverse  processes  approach  each  other,  while  in  a  true 
lateral  subluxation  the  distanc'e  between  the  transverse 
processes  on  each  side  is  the  same. 

This  form  of  displacement  is  met  with  most  commonly 
in  the  cervical  region,  since  here  the  surfaces  of  the  articular 
processes  are  fiat,  and  the  integrity  of  the  joint  is  not  sup- 
plemented by  the  ribs  as  in  the  thoracic  region,  but  is  de- 
pendent solely  on  the  muscles  and  ligaments.  In  the  thoracic 
region  such  a  subluxation  would  most  readily  occur  between 
the  tenth  and  eleventh,  and  the  eleventh  and  twelfth  verte- 
brae, since  these  are  not  reinforced  by  the  ribs.  It  is,  how- 
ever, seen  in  all  thoracic  vertebrae.  In  the  lumbar  region 
the  possibility  of  lateral  displacement  of  the  vertebrae  is  still 
less  on  account  of  the  strength  of  the  capsular  ligaments, 
and  the  fact  that  the  superior  articular  processes  so  com- 
pletely surround  the  inferior  processes  of  the  vertebra  above. 
Lateral  subluxations  are,  therefore,  seen  only  in  the  cervical 
region  and  lower  two  thoracic  vertebrae. 

For  the  production  of  a  lateral  subluxation,  even  in  the 
cervical  region,  quite  a  degree  of  violence  would  be  necessary ; 
this  is  true  for  the  reason  that  the  upper  surface  of  the  body 
of  these  vertebrae  is  concave  transversely,  and  presents  a 
projecting  lip  on  each  side;  the  lower  surface  is  convex  from 
side  to  side,  and  presents  laterally  a  shallow  concavity  which 
receives  the  corresponding  projecting  lip  of  the  adjacent 
vertebra.  For  this  reason  there  would  be  more  likely  to  occur 
a  rotation  of  these  vertebrae  with  a  gliding  of  the  surfaces 
of  the  articular  processes  over  each  other.  In  such  a  case  the 
spinous  processes  would  be  displaced  laterally  and  give  the 
impression  that  the  vertebra  was  displaced  to  the  side.  To 
determine  whether  this  is  the  case,  or  whether  the  vertebra 
is  actually  displaced  laterally,  the  transverse  processes  should 
be  palpated.  If  the  vertebra  is  not  rotated,  the  transverse 
processes  will  be  on  line  with  each  other,  while,  when  the 
vertebra  is  rotated  the  transverse  process  on  one  side  will  be 
posteriorly  displaced  while  the  transverse  process  on  the 
other  side  is  displaced  anteriorly,  depending  upon  the 
direction  of  the  rotation. 

Subluxations    which,    from    the    position    of   the    spinous 


VERTEBRAL  SUBLUXATIONS  271 

process  are  apparently  lateral,  are  consequently  in  most  cases 
either  rotary  or  unilateral  compression  subluxations.  Fig.  47. 
Anterior  Subluxatioji. — An  anterior  subluxation  is  one  in 
which  a  vertebra  is  £<nterior  t  its  adjacent  vertebrae.  This 
form  of  subluxation  js  comparatively  rare,  and  a  pure  ante- 
rior displacement  of  a  vertebra,  without  dislocation  is  prac- 
tically only  possible  iu  the  upper  cerv^ical  region  of  the  spine. 
This  is  true  owing  to  the  shape  and  placement  of  the  articular 
processes  in  the  thoracic  and  lumbar  regions.  In  the  thoracic 
region  the  surfaces  of  the  articular  processes  are  placed 
against  each  other  in  such  a  manner  as  to  practically  entirely 


Fig.  47. 
Lateral   Subluxation. 

preclude  the  possibility  of  a  forward  displacement  of  one  of 
the  vertebrae  in  this  region.  There  are,  however,  cases  in 
which  by  palpation  of  the  transverse  processes  a  vertebra 
in  this  region  is  found  to  be  anterior,  but  this  is  usually  a 
thinning  of  the  anterior  portion  of  the  disc  as  a  result  of 
which  the  anterior  part  of  the  vertebra  which  rests  upon  that 
disc  is  displaced  downward,  while  its  posterior  portion  is 
raised  and  brought  forward ;  thus  the  spinous  and  transverse 
processes  will  be  felt  as  being  close  to  those  of  the  vertebra 
above  the  one  affected. 

In  the  lumbar  region  of  the  spine  the  length  of  the  inferior 
articular  processes,  and  their  convex  surface  fitting  into  the 
concavity  on  the  tip  of  the  superior  processes  of  the  vertebra 


272 


SPINAL  ADJUSTMENT 


below,  effectively  prevent  any  forward  displacement  of  a 
vertebra  in  this  region.  The  fifth  lumbar  vertebra  is,  how- 
ever, an  exception  to  this  rule.  This  vertebra  is  wedge-shaped, 
the  thicker  portion  of  its  body  being  anterior.  This  naturally 
will  favor  a  forward  displacement  of  this  vertebra. 


Fig.  48. 

Anterior  Subluxation. 


The  most  likely  place  in  which  a  pure  anterior  displace- 
ment of  a  vertebra  could  occur  is  at  the  atlas.  Here  a  laxity 
of  the  transverse  ligament  will  permit  a  forward  displace- 
ment of  the  atlas  upon  the  condyles  of  the  occiput.  It  must 
be  understood  that  by  this  only  a  slight  displacement  is  im- 
plied, since  a  pronounced  displacement  would  necessarily 
cause  a  compression  of  the  medulla  between  the  posterior 
arch  of  the  atlas  and  the  odontoid  process  of  the  axis. 


VERTEBRAL  SUBLUXATIONS  273 

In  an  anterior  subluxation  the  antero-posterior  diameter 
of  the  intervertebral  foramina  is  encroached  upon  and  the 
nerves  and  vessels  transmitted  by  them  are  compressed. 
When  the  subluxation  is  in  the  cervical  region,  the  vertebral 
arteries  are  also  pressed  upon,  and  the  circulation  to  the  brain 
is  interfered  with.     Fig.  48. 

Posterior  Subluxation. — In  a  posterior  subluxation  the  in- 
ferior articular  processes  of  a  vertebra  project  backward  from 
the  superior  articular  processes  of  the  vertebra  below  it.  This 
displacement  almost  entirely  occludes  the  intervertebral  fora- 
men, compressing  the  structures  passing  through  it.  The 
surrounding  ligaments  are  contracted;  the  stellate  and  other 
ligaments  connecting  the  ribs  with  the  vertebrae  share  in 
this  contraction.  While  in  a  posterior  subluxation  all  the 
ligaments  are  not  always  affected,  they  might  be.  If  the 
displacement  is  marked,  the  anterior  and  posterior,  the  sub- 
flava,  and  the  ligaments  of  the  spinous  processes  will  all  be 
involved.  The  ligamenta  subflava,  which  connect  the  laminae, 
can  be  readily  palpated. 

Posterior  displacement  of  a  vertebra  is  limited  to  a  cer- 
tain extent  by  the  superior  articular  processes  of  the  vertebra 
below  the  one  displaced  pressing  against  the  posterior  part 
of  the  vertebra  above,  or  the  one  which  is  displaced.  In  some 
cases,  however,  the  capsular,  anterior,  and  posterior  ligaments 
have  become  so  lax  that  they  permit  of  an  almost  complete 
backward  displacement  of  the  vertebra. 

The  gravity  of  this  form  of  subluxation  is  still  more  appar- 
ent when  it  is  noted  that  almost  invariably  when  a  posterior 
subluxation  is  present,  such  destructive  changes  occur  in 
the  intervertebral  disc  that  a  compression  subluxation  nearly 
always  accompanies  it. 

Posterior  subluxations  occur  more  frequently  in  the 
thoracic  than  in  the  cervical  or  lumbar  regions  of  the  spine. 
This  is  due  to  the  natural  backward  curvature  of  the  vertebral 
column  in  this  section.  These  subluxations  are  usually  a 
result  of  an  injury,  or  are  produced  by  occupations  which 
require  a  constant  stooping  position. 

The  intervertebral  foramen  is  diminished  in  size  antero- 
posteriorly,  by  the  backward  displacement  of  the  body  of 
the  vertebra  which   forms  the  anterior  wall  of  the   foramen. 


274 


SPINAL  ADJUSTMENT 


The  transverse  processes  are  also  displaced  backward  equally 
on  each  side,  while  the  spinous  process  of  the  affected  vertebra 
projects  beyond  that  of  the  vertebrae  above  and  below. 
Fig.  49. 

Rotary  Subluxation. — This  form  of  subluxation  is  a  dis- 
placement of  a  vertebra  which  consists  in  a  turning  of  the 
vertebra   upon   its   axis.     As   a   result   of   this   twisting,   the 


Fig.  49. 
Tosterior  Subluxation. 

spinous  process  of  the  involved  vertebra  will  be  found  to  the 
right  or  the  left  of  the  spinous  process  of  the  vertebra  above 
and  the  one  below  it,  depending  upon  the  direction  of  the 
rotation.  The  transverse  process  on  one  side  is  displaced 
posteriorly,  while  that  on  the  other  side  is  displaced  anteriorly. 
This  turning  of  the  vertebra  produces  a  drawing  out  of 
alignment  of  the  intervertebral  disc,  and  a  tension  upon 
the  various   ligaments   anteriorly,   posteriorly,   and    laterally. 


VERTEBRAL  SUBLUXATIONS 


275 


The  articular  processes  are  displaced  posteriorly  on  one 
side,  and  to  the  side  toward  which  the  vertebra  is  rotated, 
thus  producing  a  lateral-posterior,  but  the  term  rotary  is 
preferable,  since  the  vertebra  is  turned  on  its  axis,  and  fur- 
thermore for  the  reason  that  the  posterior  form  of  displace- 
ment occurs  in  practically  all  the  other  forms  of  subluxation. 
What  has  been  said  of  the  posterior  form  will,  however,  apply 
here  to  a  less  degree,  as  the  displacement  is  limited  by  the 
size  of  the  intervertebral  foramen,  since  the  anterior  surface 
of  the  superior  articular  process  of  the  vertebra  below  would 
come  into  contact  with  the  posterior  surface  of  the  body  of 


Fig.  50. 
Rotary  Subluxation. 


the  vertebra  above  it.    This  form  of  subluxation  is  frequently 
associated  with  scoliosis. 

Rotary  subluxations  are  possible  in  all  regions  of  the 
spine,  but  occur  with  least  frequency  in  the  cervical  region, 
as  the  vertebrae  in  this  region  are  so  constructed  with  a 
downward  tilt  of  their  transverse  processes,  and  a  flange  at 
the  sides  of  the  upper  surface  of  their  body  that  they  are  well 
protected  against  any  radical  rotation.  The  normal  spine 
permits  considerable  rotation  in  this  region  without  displace- 
ment, but  this  movement  is  confined  principally  to  the  rota- 
tion of  the  atlas  upon  the  odontoid  process  of  the  axis;  the 
other  cervical  vertebrae  rotate  en  masse,  the  rotation  of  each 


276  SPINAL  ADJUSTMENT 

individual  vertebra  being  relatively  slight,  as  a  rule.  How- 
ever, the  rotary  displacement  in  this  region  may  become  pro- 
nounced when  associated  with  one  of  the  other  forms  of 
subluxation ;  it  then  becomes  a  compound  subluxation. 

In  the  lumbar  region  there  may  also  exist  a  turning  of  a 
vertebra  upon  its  axis  sufficient  to  amount  to  a  rotary 
subluxation. 

Owing  to  the  posterior  and  lateral  displacement  of  the 
articular  process  on  one  side  in  this  form  of  subluxation  the 
antero-posterior  and  lateral  diameters  of  the  intervertebral 
foramen  on  that  side  will  be  encroached  upon  and  impinge- 
ment of  the  vessels  and  nerves  passing  through  it  will  result. 
Fig.  50. 

Subluxations  in  the  Various  Regions  of  the  Spinal  Column. 
— We  have  seen  that  certain  sul)luxations  are  peculiar  to 
certain  regions  of  the  spine,  owing  to  the  shape  and  placement 
of  the  articular  processes,  while  these  same  subluxations  for 
the  same  reason  are  impossible  of  occurrence  in  other  regions 
of  the  spine. 

Grouped  according  to  the  regions  in  which  the  different 
forms  of  subluxations  are  met  with,  we  find  that  the  following 
regions  permit  of  these  forms  of  displacements : 

Region  of  Spine.  Forms  of  Subluxations. 

Cervical.  Lordc^tic  (secondary  to  kyphotic). 

Scoliotic. 

Compression. 

Supero-Inferior. 

Lateral. 

Anterior. 

Rotary. 
Thoracic.  Posterior. 

Kyphotic. 

Primary   Lordotic. 

Scoliotic. 

Compression. 

Supero-Inferior. 

•Lateral. 

Rotary. 


VERTEBRAL  SUBLUXATIONS  277 

Lumbar.  Kyphotic. 

Lordotic  (secondary  to  kyphotic). 

Scoliotic. 

Compression. 

Supero-Inferior. 

Anterior  (5th  only). 

Posterior. 

Rotary. 

The  following  table  shows  the  regions  of  the  spine  in 
which  the  various  forms  of  subluxations  may  occur : 

Posterior  Thoracic  region. 

Kyphotic  Thoracic  region,  especially. 

Lumbar  region. 
Lordotic    Primary,  Thoracic  region. 

Secondary  to  kyphotic.  Cervical  and  Lum- 
bar regions. 
Scoliotic   Primary,  Thoracic  region. 

Compensatory,    Cervical    and    Lumbar    re- 
gions. 
Compression    ....Cervical  region. 

Thoracic  region. 

Lumbar  region. 
Supero-Inferior..  .Cervical  region. 

Thoracic  region. 

Lumbar  region. 
Lateral    Cervical  region. 

Thoracic  region,  especially  the  11th  and  12th. 
Anterior   Cervical,  especially  the  Atlas. 

Fifth  Lumbar  (spondylolisthesis). 
Posterior  Cervical  region. 

Thoracic  region. 

Lumbar  region. 
Rotary   Cervical  region. 

Thoracic  region. 

Lumbar  region. 

Compound  Subluxations. — As  stated  above,  these  are  com- 
binations of  the  simple  forms  of  subluxation  described,  and 
require  no  especial  description.     Compound  subluxations  are 


278  SPINAL  ADJUSTMENT 

usually  the  only  kind  found,  since,  as  already  mentioned  the 
vertebra  is  also  displaced  posteriorly  in  nearly  all  other 
forms  of  displacement.  A  lordotic  and  an  anterior  subluxa- 
tion are  the  only  ones  in  which  a  backward  displacement  of 
the  afifected  vertebra  does  not  occur  in  combination  with 
the  displacement  in  other  directions. 


CHAPTER  V 

Spinal  Analysis 

Ha\ing  studied  the  various  forms  of  subluxations,  it  now 
becomes  necessary  to  consider  the  various  methods  which 
are  used  for  the  detection  and  determination  of  these 
displacements. 

For  the  purpose  of  making  a  correct  spinal  analysis  it  is 
necessary,  first  of  all  to  become  familiar  with  the  signs  of 
vertebral  subluxations.  These  signs  and  symptoms  are  in- 
variably present  wherever  a  subluxation  exists.  After  having 
determined  that  a  subluxation  is  present  in  a  certain  spinal 
segment,  it  next  becomes  necessary  to  use  those  methods 
which  will  show  what  the  exact  nature  of  the  displacement 
is.  It  is  only  through  such  a  knowledge  that  we  are  enabled 
to  apply  the  proper  thrust  for  the  reduction  of  subluxation. 

Under  the  chapter  on  spinal  symptomatology  the  signs 
of  vertebral  subluxations  were  described,  and  the  manner 
of  eliciting  these  signs  will  be  considered  in  this  place. 

Signs  of  Vertebral  Subluxations 

The  symptoms  and  signs  pointing  to  the  existence  of  a 
displacement  of  a  vertebra  are  the  following: 

1.  Pain. 

2.  Tenderness  of  the  nerves. 

3.  Thickened   nerve-trunks. 

4.  Variation  in  temperature. 

5.  Disturbed  function. 

6.  Contracted  ligaments. 

7.  Diminished  mobility  of  the  back. 

8.  Changes  in  the  anatomical  structures  connected  with 
the  spine. 

9.  Mal-alignment  of  the  spinous  processes. 
10.  Mal-alignment  of  the  transverse  processes. 

279 


280  SPINAL  ADJUSTMENT 

These  symptoms  and  signs  are  at  times  difficult  to  deter- 
mine, owing  to  the  excessive  muscular  development  of  some 
patients,  and  the  amount  of  adipose  tissue  which  intervenes 
between  the  bones  of  the  spinal  column  and  the  integument. 
Usually,  however,  these  disadvantages  are  not-  sufficiently 
marked  to  entirely  prevent  the  making  of  a  correct  spinal 
analysis. 

Pain. — This  is  an  unfailing  symptom  of  subluxation,  and 
points  undeniably  to  some  lesion  of  a  nerve.  The  pain  is  not 
located  at  the  point  of  the  subluxation,  but  is  referred  to  the 
peripheral  distribution  of  the  nerve  which  takes  its  origin 
in  the  spinal  segment  which  is  involved  by  the  subluxation. 
Pain,  being  a  subjective  symptom,  its  presence  can  only  be 
determined  by  questioning  the  patient.  After  the  location 
of  the  pain  has  been  ascertained  the  segment  controlling 
that  part  of  the  body  is  examined,  and  invariably  a  subluxation 
of  the  vertebra  in  that  segment  will  be  found. 

Tenderness  of  the  Nerves. — When  a  subluxation  exists 
between  two  vertebrae,  there  will  be  a  hypersensitive  area 
found  in  the  corresponding  spinal  segment,  which  is  produced 
by  the  impingement  of  the  spinal  nerve.  By  palpating  along 
the  laminae  this  tenderness  of  the  nerve  is  readily  elicited, 
and  the  patient  complains  of  pain.  On  finding  the  point  of 
greatest  tenderness,  the  end  of  the  index  finger  should  be 
pressed  down  between  the  transverse  processes,  as  this  will 
bring  it  into  contact  with  the  posterior  primary  division  of 
the  spinal  nerve,  as  it  passes  backward,  and  before  it  gives 
ofif  its  internal  and  external  branches. 

Thickened  Nerve-trunks. — The  sheath  which  contains  the 
spinal  nerve  and  the  blood-vessels  is  usually  found  to  be 
thickened  and  congested  as  a  result  of  impingement.  This 
thickening  of  the  nerve  sheath  is  readily  determined  by 
passing  the  index  finger  downward  along  the  laminae,  when 
the  nerve  will  be  felt  to  roll  beneath  the  finger.  At  all  places 
where  such  a  condition  of  the  nerve  sheaths  obtains,  a  sub- 
luxation will  be  found.  At  times  it  is  rather  difficult  to  pal- 
pate the  nerve,  especially  if  the  overlying  muscles  are  large 
or  if  there  is  present  a  marked  contraction  of  the  spinal  liga- 
ments. Ordinarily,  however,  the  thickened  nerve  may  be 
palpated  by  pressing  aside  the  muscles  and  ligaments.    When 


SPINAL  ANALYSIS  281 

in  addition  tenderness  is  found,  it  may  be  assumed  that  the 
cord  which  rolls  beneath  the  fingers  is  the  nerve. 

Variations  in  Temperature. — In  the  chapter  on  spinal 
symptomatology  we  saw  that  whenever  a  subluxation  is 
present  in  a  certain  spinal  segment,  the  cutaneous  surface 
over  that  segment  will  be  found  to  be  of  a  higher  temperature 
than  that  over  the  segments  above  and  below  it. 

Whenever  a  spinal  nerve  is  irritated  the  temperature  of 
the  spinal  segment  which  it  controls  is  increased.  This  is 
a  positive  indication  that  a  subluxation  exists  at  that  point. 

The  temperature  of  the  different  sections  of  the  back  is 
determined  by  gently  placing  the  palmar  surface  of  the  hand 
over  the  spine,  commencing  in  the  upper  thoracic  region,  and 
passing  down  the  entire  length  of  the  vertel^ral  column. 
Should  there  be  an  acute  subluxation  of  a  serious  nature, 
the  spine  will  be  hotter  at  that  point ;  if  the  subluxation  is 
a  chronic  one,  the  spine  will  be  cooler  at  that  point.  When 
a  considerable  area  of  the  spine  is  involved  in  the  abnormal 
condition,  the  spine  will  be  found  hot  to  the  touch  through- 
out its  entire  extent.  Testing  the  temperature  thus  becomes 
a  valuable  means  of  locating  an  acute  subluxation.  This 
method  of  locating  a  subluxation  is  also  known  as  the  "Heat 
Test." 

Disturbed  Function.^ — One  of  the  most  positive  symptoms 
or  signs  of  vertebral  subluxation  is  deranged  function  of  a 
certain  part,  organ,  or  system  of  the  body.  This  is  true  for 
the  reason  that  the  functional  activity  and  organic  integrity 
of  every  part  of  the  body  are  dependent  upon  proper  inner- 
vation of  that  part.  If,  therefore,  abnormal  functioning  is 
present  in  any  portion  of  the  body,  it  is  an  indication  that 
there  exists  at  some  point  interference  with  the  conduction 
of  the  nerve-impulses  essential  to  proper  and  uninterrupted 
activity  of  such  a  part.  The  place  at  which  this  interference 
occurs  is  at  the  intervertebral  foramen  where  the  nerve 
passes  between  movable  vertebrae.  If  symptoms  referable 
to  a  certain  organ  of  the  body  are  present,  and  the  spinal 
segments  from  which  this  organ  receives  its  innervation  are 
then  examined,  it  will  always  be  noted  that  a  subluxation  of 
the  vertebrae  in  this  section  is  present. 

Deranged  function  thus  is  a  positive  sign  of  subluxation 


282  SPINAL  ADJUSTMENT 

of  a  certain  vertebra  when  a  certain  organ  is  affected.  It 
thus  becomes  just  as  possible  to  say  with  certainty  that  a 
subluxation  will  be  found  at  a  certain  segment  of  the  spine 
when  it  is  known  that  a  certain  organ  is  affected,  as  it  is  to 
state  that  a  certain  organ  is  affected  when  a  subluxation  is 
found  in  the  segment  which  controls  that  organ. 

Contracted  Ligaments. — As  has  been  previously  explained, 
no  abnormal  condition  exists  in  the  body  for  any  length  of 
time  without  the  production  of  rigidity  of  the  muscles  in  the 
vicinity  of  the  lesion.  So  also,  in  the  case  of  vertebral  sub- 
luxations there  is  always  found  a  contraction  of  the  muscles 
and  ligaments  in  the  vicinity  of  the  subluxated  vertebrae. 
This  contraction  is  sometimes  due  to  the  subluxation  when 
the  latter  is  produced  by  external  influences ;  on  the  other 
hand,  it  may  itself  be  the  producing  cause  of  the  subluxation, 
as  where  displacements  are  produced  refiexly.  In  any  event, 
contraction  of  the  ligaments  in  a  certain  spinal  segment  is  a 
positive  sign  of  the  existence  in  that  segment  of  a  subluxation. 
If  the  muscles  are  hard  and  indurated,  showing  that  they 
have  been  contracted  for  a  prolonged  period,  it  is  an  indi- 
cation that  the  subluxation  has  existed  for  a  long  time ;  in 
other  words  is  chronic.  If,  however,  the  ligaments  are  merely 
contracted,  it  shows  that  the  subluxation  is  more  recent,  and, 
therefore,  acute. 

Ligamentous  and  muscular  contractions  are  detected  by 
palpating  the  spine,  by  passing  the  fingers  along  the  laminae. 

If  the  muscular  and  ligamentous  contraction  is  only  on 
one  side  it  will  indicate  that  the  vertebra  is  probably  dis- 
placed toward  that  side.  If  the  contraction  exists  on  both 
sides  of  a  vertebra,  it  is  a  sign  that  the  vertebra  is  not  dis- 
placed toward  one  side  more  than  another.  In  this  way 
contractures  of  the  ligaments  not  only  are  a  sign  of  a  sub- 
luxation, but  also  assist  in  the  determination  of  the  nature 
of  the  vertebral  displacement. 

That  contracted  ligaments  are  a  sign  of  subluxations  and 
also  a  cause,  is  proven  by  the  fact  that  as  soon  as  a  dis- 
placement of  a  vertebra  is  adjusted  the  contraction  of  the 
ligament  disappears.  In  fact,  it  is  by  relieving  the  contrac- 
tion of  the  ligaments,  in  most  cases,  that  we  reduce  the  sub- 
luxation when  the  thrust  is  applied.    It  can  be  safely  assumed 


SPINAL  ANALYSIS  283 

that  the  majority  of  subluxations  are  either  partly  or  entirely 
dependent  for  their  existence  upon  contraction  of  the  liga- 
ments which  normally  hold  the  vertebrae  in  their  proper 
position.  It  is  this  contraction  which  draws  the  vertebra  out 
of  alignment,  and  then  makes  the  condition  permanent  be- 
cause of  the  continuous  contraction  or  because  the  ligament 
has  been  drawn  beyond  the  limit  of  its  elasticity  and  is  unable 
to  return  to  its  original  state.  As  a  result  of  this  contracted 
condition  the  vertebra  remains  in  its  abnormal  position  until 
the  displacement  is  mechanically  corrected. 

Diminished  Mobility  of  the  Spine. — When  a  joint  in  any 
part  of  the  body  is  diseased,  rigidity  of  the  surrounding  mus- 
cles, and  immobility  are  invariably  present.  This  is  true  also 
of  the  spinal  column,  and  diminished  mobility  of  the  spine 
therefore,  is  one  of  the  most  certain  and  constant  symptoms 
of  a  subluxation  of  a  vertebra  or  group  of  vertebrae. 

Various  tests  are  used  to  determine  subluxation  of  cer- 
tain portions  of  the  vertebral  column  by  the  degree  of  motion 
possible  in  them.  The  signs  of  subluxation  in  different  regions 
of  the  spine  are  as  follows : 

Subluxation  of  the  Atlas  is  indicated  by  inability  to 
execute  the  nodding  movement  of  the  head  freely  and 
painlessly. 

Subluxation  of  the  Axis  is  shown  by  inability  to  turn  the 
face  easily  from  one  side  to  the  other. 

Subluxation  of  the  other  cervical  vertebrae  is  determined 
by  inability  to  flex  the  head  freely  and  painlessly. 

Subluxation  of  the  thoracic  vertebrae  is  indicated  by  in- 
creased prominence  of  one  side  of  the  trunk,  diminished  flexi- 
bility of  a  portion  of  the  spine,  or  a  deviation  of  the  vertebral 
column  toward  one  side,  when  the  patient  is  instructed  to 
bend  the  body  forward,  and  then  backward.  These  signs 
point  to  contraction  of  the  ligaments  and  diminished  mobility 
of  the  vertebral  column,  which  are  signs  of  subluxation.  Should 
ankylosis  of  the  bodies  of  the  vertebrae  be  present,  there  will 
exist  a  space  involving  two  or  more  vertebrae,  where  the 
spinous  processes  do  not  separate,  with  the  production  of  a 
sharp  angle  in  the  spine  at  the  point  where  the  ankylosis  dis- 
continues, in  flexion  and  extension  movements  alike.  To  test 
still  further  for  ankylosis,  especially  in  the  lower  dorsal  and 


284  SPINAL  ADJUSTMENT 

upper  lumbar  regions,  the  patient  should  flex  sideways,  then 
rotate  the  body  from  side  to  side  and  backwards.  This  test  is 
positive,  since  the  nature  of  the  joints  of  the  vertebral  column 
should  admit  of  a  certain  degree  of  movement  in  any  direction 
in  each  joint,  that  is  to  the  extent  permitted  by  conformation 
of  the  bones  and  the  limitations  of  muscular  and  ligamentous 
tension.  A  further  test  for  ankylosis  in  the  lower  dorsal  and 
lumbar  regions  is  the  following:  Place  the  patient  in  the 
prone  position ;  with  the  right  hand  of  the  operator  placed 
under  the  anterior  superior  portion  of  the  ilium  of  the  opposite 
side  to  that  on  which  he  stands,  and  the  heel  of  the  left  hand 
against  the  spinous  processes  nearest  him,  he  draws  the  ilium 
towards  himself  and  at  the  same  time  pushes  the  spinous 
processes  in  the  opposite  direction ;  if  the  vertebrae  do  not 
move  laterally,  it  is  a  sign  that  lateral  ankylosis  is  present. 
To  determine  ankylosis  of  the  bodies  of  the  vertebrae  the  left 
hand  is  placed  on  the  tips  of  the  spinous  processes  and  pres- 
sure applied,  while  traction  is  made  upon  the  pelvis  with  the 
right  hand ;  if  then  the  vertebrae  fail  to  move,  it  indicates 
ankylosis  of  the  bodies  of  the  vertebrae.  To  determine  the 
presence  of  ankylosis  of  the  spinous  processes,  articular  proc- 
esses, or  laminae  the  patient  is  instructed  to  bend  forward 
while  the  operator  places  his  hand  on  the  spinous  processes ; 
if  the  spines  fail  to  separate,  ankylosis  of  the  spinous  processes 
is  present. 

Subluxation  of  the  lumbar  vertebrae  is  detected  in  the  same 
manner  as  that  of  the  dorsal  region. 

Changes  in  the  Anatomical  Structures  Connected  with  the 
Spine. — Changes  in  the  height  and  prominence  of  the  scapulae, 
the  prominence  of  the  angles  of  the  ribs,  and  the  prominence 
of  the  iliac  crests  are  signs  of  vertebral  subluxation. 

To  ascertain  any  undue  unilateral  prominence  of  the  angles 
of  the  ribs  the  patient  is  placed  in  the  Adams  position,  namely, 
standing  with  the  heels  together,  and  the  body  bending 
forward  until  the  head  and  trunk  are  horizontal,  and  with 
the  arms  hanging.  The  angles  of  the  ribs  are  then  left 
uncovered  by  the  scapulae  and  any  prominence  on  either 
side  may  be  readily  noted.  Such  unilateral  prominence  of 
the  angles  of  the  ribs  indicates  a  rotation  of  the  vertebrae  on 
their  axes. 


SPINAL  ANALYSIS  285 

Dififerences  in  the  height  of  the  scapulae  or  iliac  crests  arc 
noted  by  having  the  patient  in  the  erect  posture  either  sitting 
or  standing,  with  the  arms  hanging  at  his  sides.  Such  dififer- 
ences, when  present,  indicate  scoliosis. 

Mal-Alignment  of  the  Spinous  Processes. — The  position  of 
the  spinous  processes  is  a  valuable  sign  of  a  subluxation. 
This  is  especially  true  in  the  cervical  and  lumbar  region.  In 
the  thoracic  region,  however,  the  spinous  processes  may  pro- 
ject from  the  union  of  the  laminae  at  an  abnormal  angle.  Pal- 
pation of  the  tips  of  the  si)inous  processes  may  in  such  cases 
become  misleading,  and  in  any  case  is  not  to  be  entirely  de- 
pended upon;  confirmatory  evidence  must  be  obtained  in  all 
instances  by  palpation  of  the  transverse  processes.  If  it  can 
l>e  definitely  ascertained  that  the  spinous  process  of  a  certain 
vertebra  is  really  out  of  alignment,  then  it  becomes  positive 
evidence  that  the  vertebra  of  which  it  is  a  part  is  moved  in 
its  entirety,  for  one  part  of  a  vertebra  can  not  be  moved  inde- 
pendently of  its  other  portions. 

Mal-Alignment  of  the  Transverse  Processes. — The  position 
of  the  transverse  processes  is  a  more  positive  indication  of  the 
presence  and  nature  of  a  vertebral  subluxation  in  any  region 
of  the  spine  than  is  that  of  the  spinous  processes.  Palpation 
of  the  transverse  processes  is  sometimes  difficult  in  subjects 
who  are  very  muscular  or  adipose,  but  after  some  experience 
in  palpation  this  difficulty  is  overcome,  and  palpation  of  the 
transverse  processes  is  readily  performed. 

Method  of  Palpation  of  the  Spinous  Processes. — In  pal- 
pating the  tips  of  the  spinous  processes  one  may  commence 
either  in  the  lumbar  region  and  pass  upward,  or  begin  with 
the  first  thoracic  vertebra  and  pass  downward.  Some  prefer 
the  former  method,  while  others  follow  the  latter  procedure. 
There  is  no  apparent  advantage  in  either  method,  and  it  is 
largely  a  question  of  habit.  Some  find  it  easier  to  keep  in 
mind  the  exact  vertebra  palpated  by  counting  from  below  up- 
ward, while  others  find  the  downward  palpation  and  counting 
more  easy. 

In  palpating  the  spinous  processes  each  one  should  be 
felt  and  the  exact  point  of  position  of  its  tip  marked  on  the 
skin  overlying  it. 

The  spine  as  a  whole  is  then  inspected  with  a  view  to 


286 


SPINAL  ADJUSTMENT 


Fig.  51. 
Palpation  of  Transvej'se  Processes. 


SPINAL  ANALYSIS  287 

determining  the  correctness  of  the  findings  on  palpation,  since 
inspection  of  the  tips  of  the  spines  is  often  a  more  certain  and 
accurate  method  than  is  palpation. 

Method  of  Palpation  of  the  Transverse  Processes. — As 
mentioned  above,  excessive  adiposity  or  great  muscular  de- 
velopment sometimes  prevent  the  satisfactory  palpation  of 
the  transverse  processes.  In  such  an  event  we  must  rely 
upon  the  palpation  of  the  spinous  processes  and  the  finding  of 
contracted  ligaments  on  one  side  of  the  affected  segment,  and 
also  tenderness  of  the  nerve  on  that  side. 

In  palpating  the  transverse  processes  some  authors  ad- 
vise the  use  of  the  tips  of  the  first  three  fingers  of  each  hand; 
one  finger  being  placed  on  a  transverse  process  in  such  a  man- 
ner as  to  enable  the  palpator  to  make  comparison  between 
three  vertebrae.  This  method  has  its  advantages  in  that  the 
operator  is  enabled  by  this  means  to  quickly  make  a  diagnosis 
of  the  position  of  a  vertebra  with  reference  to  that  of  the 
vertebrae  above  and  below  it. 

It  however  requires  much  experience  to  become  proficient 
in  this  method  of  palpation  of  the  transverse  processes.  This 
is  true  for  the  reason  that  the  ability  to  distinguish  between 
the  three  distinct  sensations  of  the  three  fingers  used  is 
acquired  only  after  much  practise  by  all  operators,  while  some 
are  never  able  to  master  it.  The  sensation  is  always  more 
acute  in  one  finger  and  palpation  of  a  single  vertebra  at  a 
time  is  therefore  to  be  preferred.  This  is  true  especially  in 
those  who  are  learning  spinal  analysis,  and  in  whose  finger 
tips  the  sense  of  touch  is  not  highly  developed. 

In  our  opinion,  therefore,  palpation  of  the  transverse  proc- 
esses is  best  performed  by  using  that  finger  in  which  the 
sense  of  touch  is  most  highly  developed,  which  varies  in  differ- 
ent individuals.  In  this  way  the  transverse  process  of  a  ver- 
tebra can  be  palpated  on  each  side  and  comparison  then  made 
with  the  ones  above  and  below  it.  There  is  no  special  ad- 
vantage to  be  derived  in  feeling  the  transverse  processes  of 
three  vertebrae  simultaneously.  The  index  finger  may,  for 
example,  be  placed  on  the  skin  in  such  a  manner  that  it  can  be 
made  to  glide  over  the  transverse  processes  of  three  vertebrae 
in  one  movement  by  simply  moving  the  skin  along  over  the 
vertebrae.      In    this   way   diflferences   in   the   position    of   the 


288 


SPINAL  ADJUSTMENT 


F;g.  52. 
The  Adams  Position. 


SPINAL  ANALYSIS  289 

transverse  processes  of  any  of  these  three  vertebrae  will  be 
readily  noted. 

Position  of  the  Patient 

In  making  examinations  of  the  spine  a  certain  definite 
procedure  should  be  followed.  The  first  essential  to  a 
thorough  and  complete  examination  of  the  spine  is  the  proper 
position  of  the  patient.  Some  displacements  of  the  vertebrae 
are  more  recognizable  in  one  position  than  another,  and  it 
therefore  becomes  necessary  to  place  the  patient  in  various 
positions  in  order  that  nothing  may  escape  the  attention  of 
the  examiner. 

For  the  purpose  of  making  a  spinal  analysis  the  following 
positions  are  the  most  useful : 

The  Erect  position. 
The  Prone  position. 
The  Dorsal  position. 
The  Adams  position. 

The  Adams  Position. — In  this  position  the  patient  stands 
with  his  heels  together  and  bends  forward  without  flexing  the 
knees  until  the  trunk  is  in  a  horizontal  position,  with  the  arms 
hanging. 

With  the  patient  in  this  attitude  we  note  the  position  of  the 
spinous  processes,  and  observe  any  that  may  be  out  of  align- 
ment. Further,  we  note  any  diminution  of  mobility  in  any 
section  or  segment  of  the  spine.  If  a  certain  section  of  the 
spine  shows  diminished  elasticity,  it  is  an  indication  of  the 
presence  of  ankylosis;  there  will  exist  a  space  involving  two 
or  more  vertebrae  where  the  spinous  processes  do  not  sepa- 
rate, and  there  is  evident  a  more  or  less  sharp  angle  at  the 
point  where  the  ankylosis  discontinues,  wdiich  will  also  be 
true  when  the  patient  bends  the  trunk  backward.  To  test 
still  further  for  ankylosis,  especially  in  the  lower  dorsal  and 
upper  lumbar  regions,  have  the  patient  flex  the  trunk  side- 
ways, then  rotate  from  side  to  side.  This  test  is  positive  as 
the  nature  of  the  joints  of  the  spinal  column  is  such  that  they 
should  permit  of  a  certain  degree  of  motion  in  any  direction, 
in  each  joint,  to  the  extent  of  the  limitation  due  to  contact  of 
the  bones  and  muscular  and  ligamentous  tension.    Diminished 


290 


SPINAL  ADJUSTxMENT 


Fig.  53. 

The  Erect  Position. 


SPINAL  ANALYSIS  291 

mobility  of  a  certain  segment  of  the  spine  indicates  contrac- 
tion of  the  ligaments  of  that  particular  segment.  When  the 
spine  does  not  become  flexed  in  a  perfectly  straight  Hne,  it 
indicates  a  contracted  condition  of  the  muscles  and  ligaments 
on  the  side  toward  which  the  deviation  occurs.  Lastly  this 
position  will  reveal  any  unilateral  prominence  of  the  angles 
of  the  ribs  which  is  present  when  the  vertebrae  are  rotated. 

•  The  Prone  Position. — In  this  position  the  patient  lies  face 
down  on  a  flat  table.  While  in  this  position  we  note  the  posi- 
tion of  the  spinous  and  transverse  processes.  The  temperature 
variations  which  are  present  are  also  noted  with  the  patient 
in  the  prone  position.  Tenderness  of  the  nerves,  thickening 
of  the  nerve-trunks,  and  contractures  of  the  ligaments  of  the 
spine  are  also  palpated.  This  is  the  position  which  we  have 
the  patient  assume  for  the  purpose  of  palpation  of  the  spine 
and  parts  associated  therewith. 

Further,  a  test  for  ankylosis  is  made  with  the  patient  in 
the  prone  position.  Place  the  right  hand  under  the  anterior 
superior  portion  of  the  ilium  of  the  side  opposite  to  that  on 
which  the  examiner  stands.  The  operator  then  draws  the 
pelvis  upward  and  presses  the  spinous  processes  in  the  op- 
posite direction ;  this  will  determine  the  presence  or  absence 
of  ankylosis  of  the  articular  processes.  To  ascertain  the 
presence  of  ankylosis  of  the  bodies  of  the  vertebrae  place  the 
left  hand  on  the  tips  of  the  spinous  processes  and  press  down- 
ward, at  the  same  time  raising  the  pelvis  with  the  right  hand. 

The  Dorsal  Position. — In  this  position  the  patient  lies  on 
a  flat  table  on  his  back.  This  is  the  only  position  in  which  the 
cervical  vertebrae  may  be  palpated.  By  flexing  the  neck  and 
supporting  the  head  with  the  hands  the  spinous  processes  can 
be  easily  palpated,  and  any  changes  from  the  normal  in  their 
position  noted.  The  transverse  processes  are  next  palpated 
with  the  index  and  middle  finger. 

The  Erect  Position. — The  patient  may  either  be  seated 
upon  a  chair,  or  stand  erect  with  his  heels  together  and  his 
hands  hanging  at  his  side.  (Fig.  53.)*  The  following  observa- 
tions are  made  with  the  patient  in  this  position :  The  position 
of  the  spinous  processes  is  first  noted.  The  curvatures  of  the 
spine  are  also  noted  with  the  patient  in  this  position,  and 
viewed  from  the  side.     The  angles  of  the  ribs  are  observed, 


292 


SPINAL  ADJUSTMENT 


Fig.  54. 

Spinal   Adjustment  Table. 


SPINAL  ANALYSIS  293 

and  any  prominence  of  a  certain  rib  due  to  a  rotation  of  the 
vertebra  with  which  it  is  connected  noted  with  the  patient 
erect.  The  comparative  height  and  prominence  of  the  scap- 
ulae is  seen.  The  pelvic  inclination  and  the  comparative 
height  of  the  iliac  crests  is  noted  with  the  patient  in  this 
posture. 

The  Diagnosis  of  Subluxations 

In  addition  to  the  symptoms  and  signs  of  subluxations 
which  are  subjective,  and  have  already  been  described,  three 
other  methods  are  used  for  the  determination  of  the  exact 
nature  of  the  subluxation.  By  the  methods  thus  far  con- 
sidered we  are  enabled  to  say  positively  that  a  displacement 
of  a  vertebra  is  present ;  the  direction  of  this  displacement  can, 
however,  only  be  determined  by  the  following  methods : 

Inspection. 
Palpation. 
The  X-ray. 

Inspection. — By  inspection  we  note  the  following  points: 

1.  Alal-alignment  of  the  spinous  processes. 

Lateral  deviation  of  a  spinous  process  indicates  a  lateral 
or  rotary  subluxation,  and  is  noted  by  yiewing  the  patient 
from  behind  in  the  erect  position,  or  looking  at  the  spine  with 
the  patient  in  the  prone  position.  If  a  group  of  vertebrae 
are  thus  affected  it  indicates  scoliosis. 

Approximation  of  a  spinous  process  with  the  one  below 
it  indicates  a  compression  subluxation,  or  a  supero-inferior 
subluxation. 

Backward  deviation  of  a  spinous  process  denotes  a  pos- 
terior subluxation.  If  a  group  of  vertebrae  are  thus  affected, 
it  indicates  kyphosis. 

Forward  displacement  of  a  spinous  process  is  a  sign  of  an 
anterior  subluxation.  If  there  is  a  forward  deviation  of  a 
group  of  vertebrae  it  means  lordosis. 

2.  Diminished  mobility  of  the  back. 

3.  Undue  prominence  of  the  angle  of  a  rib  or  number  of 
the  ribs. 

If  this  prominence  is  bilateral  it  denotes  a  posterior  sub- 
luxation or  kyphosis. 


294 


SPINAL  ADJUSTMENT 


Fig.  55. 

Spinal   Adjnstiuoiit  Table. 


SPINAL  ANALYSIS  295 

When  it  is  unilateral  it  indicates  a  rotary  subluxation  or 
scoliosis. 

4.  Tilting  of  the  pelvis. 

The  pelvis  is  lower  on  the  side  toward  which  a  scoliosis  is 
directed. 

Palpation. — By  palpation  we  note  the  following:   ' 

1.  Local  zone  of  increased  temperature,  which  points  to 
the  existence  of  a  subluxation  at  that  point,  but  does  not  give 
any  clew  as  to  the  nature  of  the  displacement. 

2.  Contraction  of  the  spinal  muscles  and  ligaments. 

If  this  is  unilateral,  it  denotes  a  deviation  of  the  vertebra 
toward  that  side  on  which  the  contraction  exists.  There  may 
thus  be  a  lateral,  rotary,  supero-inferior,  or  scoliotic  sub- 
luxation in  such  a  case. 

If  the  ligamentous  contraction  is  bilateral,  it  indicates 
either  a  posterior,  anterior,  kyphotic,  or  lordotic  subluxation. 

3.  Tenderness  on  palpation  of  a  nerve  indicates  a  sub- 
luxation at  the  spinal  segment  from  which  that  nerve  arises, 
but  afifords  no  information  regarding  the  nature  of  the  ver- 
tebral displacement. 

4.  Thickening  of  the  nerve-trunk,  as  felt  on  palpation,  is 
also  conclusive  evidence  of  a  subluxation  at  that  segment, 
but  is  of  no  value  in  determining  the  direction  of  the  dis- 
placement of  the  vertebra. 

5.  Mal-alignment  of  the  Spinous  and  Transverse  Processes. 
— Palpation  of  the  individual  vertebrae  is  the  most  important 
method  of  determining  the  presence  of  a  subluxation  and  its 
character. 

Various  methods  have  been  devised  for  palpating  the 
spinous  and  transverse  processes,  none  of  which  is  perfect 
in  itself,  for  the  reason  that  a  method  which  suits  one  palpator 
will  be  impossible  of  use  by  another.  In  the  author's  opinion 
no  set  rule  should  be  laid  down  for  the  method  of  palpating 
the  vertebrae,  but  this  should  be  left  to  the  individual  prefer- 
ence of  the  operator.  We  prefer  the  use  of  only  one  finger 
in  palpation  of  the  spine,  since  the  sense  of  touch  is  more 
acute  in  one  finger  than  when  two  or  three  fingers  are  em- 
ployed at  the  same  time. 

The  position  of  the  patient  is  important.  For  palpation 
of  the  thoracic  and  lumbar  vertebrae  he  should  lie  prone  upon 


296 


SPINAL  ADJUSTMENT 


Fig.  56. 
Prone  Position — Palpation  of  Spinous  Processes. 


SPINAL  ANALYSIS  297 

an  adjustment  table,  the  front  section  of  which  is  slightly 
lowered.  The  portion  of  the  table  which  supports  the  chest 
should  be  narrower  than  other  parts  of  the  table  in  order  to 
permit  the  arms  to  hang  vertically.  The  table  should  afford 
perfect  comfort  to  the  patient  so  that  complete  relaxation 
obtains.  In  palpating  the  cervical  vertebrae  the  patient 
should  be  in  the  dorsal  position,  with  the  neck  slightly  flexed. 
(Figs.  54  and  55.) 

In  palpating  the  spinous  processes  the  balls  of  the  first 
three  fingers  may  be  used.  The  ends  of  the  fingers  are  placed 
directly  upon  the  tips  of  three  spinous  processes,  and  their 
relative  position  then  carefully  noted.  (Fig.  56.)  The  same 
findings  enumerated  under  the  heading  of  inspection  of  the 
spinous  processes  apply  here,  and  repetition  is  unnecessary. 
In  any  event  palpation  of  the  spinous  processes  is  of  far  less 
importance  than  that  of  the  transverse  processes,  for  the  rea- 
son that  there  is  often  a  deviation  in  the  direction  of  projection 
of  the  spinous  processes,  as  our  dissections  of  spines  frequently 
demonstrate.  Were  the  position  of  the  tip  of  the  spinous 
process,  therefore,  to  be  taken  as  the  sole  guide  in  the  diag- 
nosis of  the  nature  of  a  subluxation  many  erroneous  con- 
clusions would  constantly  be  drawn  therefrom.  In  dissection 
of  the  human  body  we  have  found  many  times  that  what  ap- 
peared upon  the  surface  to  be  a  subluxation,  judged  by  the 
position  of  the  tip  of  the  spinous  process,  was  afterward 
found  to  be  simply  a  distorted  spinous  process ;  either  it  was 
twisted,  or  it  had  grown  in  an  abnormal  direction.  Such 
evidence  as  is  obtained  by  palpation  of  the  spinous  processes 
is  therefore  not  to  be  relied  upon,  but  in  every  instance  con- 
firmatory evidence  must  be  sought  for  by  a  careful  palpation 
of  the  transverse  processes. 

In  palpating  the  transverse  processes  the  palmar  surface 
of  the  index-finger  should  be  used.  (Fig.  57.)  The  use  of  the 
three  first  fingers  in  palpation  is  confusing,  especially  to  the 
novice,  and  in  fact  requires  long  experience  to  educate  the 
sense  of  touch  in  the  three  fingers  to  such  a  degree  as  to 
make  it  possible  for  one  to  interpret  the  three  sensations 
simultaneously.  The  palmar  surface  of  the  index  finger 
should  be  placed  firmly  on  the  transverse  processes  on  either 
side  of  the  spinous  processes.     The  fingers  should  then  be 


298 


SPINAL  ADJUSTMENT 


Fig.  57. 
Palpation-  of  Transverse  Processes. 


SPINAL  ANALYSIS  299 

made  to  glide  over  three  transverse  processes  in  one  move- 
ment, moving  the  skin  along  beneath  them.  In  this  way  the 
position  of  three  transverse  processes  is  determined  with 
reference  to  each  other.  Individual  palpation  of  each  trans- 
verse process  may  then  follow,  and  the  position  of  the  trans- 
verse process  on  each  side  of  the  vertebra  which  is  displaced 
should  be  determined  for  the  purpose  of  ascertaining  the  exact 
nature  of  the  subluxation.  The  following  are  the  conclusions 
to  be  drawn  from  the  position  of  the  transverse  processes : 

When  the  transverse  processes  of  a  vertebra  are  displaced 
backward  equally  on  each  side,  it  indicates  that  the  vertebra 
is  displaced  backward  as  a  whole,  and  denotes  a  posterior 
subluxation. 

If  the  transverse  processes  of  a  vertebra  are  displaced  for- 
ward to  an  equal  extent  on  each  side,  it  indicates  an  anterior 
subluxation. 

When  the  transverse  processes  project  laterally,  as  shown 
in  the  cervical  region  by  palpating  their  extremities,  and  in 
the  thoracic  region  by  noting  that  the  transverse  process  on 
one  side  is  drawn  toward  the  line  of  the  spinous  processes 
while  the  one  on  the  other  side  is  drawn  away  from  this  line, 
a  lateral  subluxation  is  present.  In  this  case  the  transverse 
process  on  either  side  does  not  project  backward,  but  both 
are  perfectly  level. 

If  the  transverse  process  on  one  side  of  a  vertebra  is  dis- 
placed forward,  while  that  on  the  other  side  is  backward,  it 
shows  that  the  vertebra  is  turned  on  its  axis,  and  a  rotary 
subluxation  is  present. 

When  the  transverse  processes  of  a  vertebra  are  nearer 
the  vertebra  below  than  the  vertebra  above,  it  indicates  that 
the  upper  vertebra  is  approximated  to  the  one  below  it,  and 
that  the  disc  between  them  is  thinned.  This  condition  is 
known  as  a  compression  subluxation. 

If  the  transverse  process  of  one  side  of  a  vertebra  is 
nearer  than  normal  to  the  corresponding  transverse  process  of 
the  vertebra  below,  a  compression  of  that  side  of  the  inter- 
vertebral disc  is  present.  The  vertebra  in  such  instances  is 
nearer  the  vertebra  on  that  side,  while  on  the  other  side  the 
distance  between  the  two  vertebrae  is  increased.  This  is 
known  as  a  supero-inferior  subluxation. 


300  SPINAL  ADJUSTMENT 

When  the  transverse  processes  of  a  group  of  vertebrae  are 
displaced  backward  and  are  close  to  each  other,  a  kyphosis  is 
present. 

When  the  transverse  processes  of  a  group  of  vertebrae  are 
displaced  forward  a  lordotic  subluxation  is  indicated. 

When  the  transverse  processes  are  displaced  toward  the 
side,  a  scoliosis  is  indicated.  A  rotary  subluxation  is  fre- 
quently associated  with  scoliosis,  in  which  case  there  will  be 
a  backward  displacement  of  the  transverse  process  on  one 
side. 

Diagnostic  Signs  of  Each  Form  of  Subluxation, 

Posterior  Subluxation. — The  spinous  process  is  displaced 
backward. 

The  transverse  processes  are  displaced  backward  to  the 
same  extent  on  each  side. 

The  ligaments  on  both  sides  are  contracted. 

The  nerve-trunks  on  each  side  are  thickened. 

There  is  tenderness  of  the  nerves  on  pressure,  unless  the 
subluxation  is  chronic. 

There  may  be  a  local  zone  of  increased  temperature, 
especially  if  the  subluxation  is  acute. 

Disease  in  a  certain  organ,  system,  or  part  of  the  body. 

The  angles  of  the  ribs  will  be  prominent  in  the  thoracic 
region. 

Anterior  Subluxation. — The  spinous  process  is  displaced 
forward. 

The  transverse  processes  are  displaced  forward  equally  on 
each  side. 

The  ligaments  on  both  sides  are  contracted. 

The  nerve-trunks  on  each  side  are  thickened. 

There  is  tenderness  of  the  nerves  on  each  side,  unless  the 
subluxation  is  chronic. 

There  may  be  a  local  zone  of  increased  temperature.' 

Disease  in  some  organ,  part,  or  system  of  the  body. 

Compression  Subluxation. — The  spinous  processes  of  two 
vertebrae  are  approximated,  that  of  the  subluxated  vertebra 
downward  upon  the  vertebra  below. 

The  transverse  processes  on  both  sides  of  two  vertebrae 
are  approximated. 


SPINAL  ANALYSIS  301 

The  ligaments  on  both  sides  are  contracted. 

The  nerve-trunks  on  each  side  are  thickened.' 

There  is  tenderness  of  the  nerves  on  each  side  unless  the 
subluxation  is  chronic. 

The  temperature  of  the  corresponding  part  of  the  back 
may  be  increased. 

Disease  in  a  certain  part  of  the  body. 

Supero-Inferior  Subluxation. — The  spinous  process  is 
displaced  toward  the  side  away  from  the  side  compressed. 

The  transverse  process  is  displaced  downward  on  the 
compressed  side,  while  that  of  the  other  side  is  raised. 

The  ligaments  on  the  side  which  is  displaced  downward 
are  contracted. 

The  nerve-trunks  on  the  compressed  side  are  thickened. 

There  is  tenderness  of  the  nerve  on  the  side  which  is  com- 
pressed. 

The  temperature  of  the  zone  supplied  by  the  impinged 
nerve  is  increased. 

Disease  in  a  certain  portion  of  the  body. 

Lateral  Subluxation. — The  spinous  process  is  displaced  to 
one  side. 

The  transverse  process  projects  laterally  in  the  cervical 
region,  and  in  the  thoracic  region  the  transverse  process  on 
one  side  is  drawn  away  from  the  line  of  the  spinous  processes, 
while  on  the  other  side  it  approaches  this  line. 

The  ligaments  on  the  side  toward  which  the  vertebra  is 
displaced  are  contracted. 

The  nerve-trunks  on  the  side  toward  which  the  vertebra  is 
displaced  are  thickened. 

There  is  tenderness  on  the  side  toward  which  the  vertebra 
is  displaced. 

There  is  a  zone  of  increased  temperature  corresponding  to 
the  segment  supplied  by  the  impinged  nerve. 

Disease  in  a  certain  portion  of  the  body. 

Rotary  Subluxation. — The  spinous  process  is  displaced 
slightly  to  one  side. 

The  transverse  process  of  one  side  is  forward,  while  on 
the  side  on  which  the  subluxation  exists  it  is  backwardly  dis- 
placed. 

The  ligaments  on  the  subluxated  side  are  contracted. 


302  SPINAL  ADJUSTMENT 

The  nerve-trunks  on  the  subluxated  side  are  thickened. 

There  is  tenderness  on  the  subluxated  side. 

The  temperature  of  the  corresponding  segment  of  the  back 
is  increased. 

The  angle  of  the  corresponding  rib  is  displaced  backward. 

Disease  in  the  parts  supplied  by  the  impinged  nerve,  de- 
pending on  the  location  of  the  subluxation. 

Kyphotic  Subluxation. — The  spinous  processes  are  dis- 
placed and  the  distance  between  them  increased. 

The  transverse  processes  are  displaced  posteriorly  and 
separated. 

The  ligaments  of  the  corresponding  part  of  the  vertebral 
column  are  contracted. 

The  nerve-trunks  are  thickened. 

There  is  tenderness. 

The  temperature  of  the  part  of  the  back  affected  is  in- 
creased. 

The  angles  of  the  ribs  are  prominent  on  both  sides. 

Mobility  of  the  aft'ected  portion  of  the  back  is  diminished 
or  absent. 

Lordotic  Subluxation. — The  spinous  processes  are  dis- 
placed anteriorly  and  set  close  to  each  other. 

The  transverse  processes  on  both  sides  are  displaced  for- 
ward and  approximated. 

The  ligaments  are  contracted  on  both  sides. 

The  nerve-trunks  are  thickened. 

Tenderness  is  present,  unless  the  subluxation  is  chronic 
and  the  nerve  is  compressed. 

The  temperature  of  the  corresponding  portion  of  the  back 
is  increased. 

Mobility  of  the  affected  part  of  the  vertebral  column  is 
diminished  or  absent. 

The  pelvic  inclination  is  increased. 

Scoliotic  Subluxation. — The  spinous  processes  are  dis- 
placed laterally. 

The  transverse  processes  are  displaced  to  the  side,  and 
rotation  of  the  vertebrae  is  frequently  present. 

The  ligaments  on  the  impinged  side  are  contracted  and 
indurated. 

The  nerve-trunks  on  the  subluxated  side  are  thickened. 


SPINAL  ANALYSIS  303 

Tenderness  is  present  unless  the  condition  is  chronic. 

The  temperature  of  the  affected  portion  of  the  back  is 
increased. 

The  angles  of  the  ribs  on  the  side  toward  which  the  lateral 
curvature  is  directed  are  prominent. 

The  pelvis  is  tilted  up  on  the  side  toward  which  the 
curvature  is  directed  and  down  on  the  other  side. 

The  scapulae  are  affected  in  the  same  manner  as  the  pelvis, 
namely  that  on  the  side  toward  which  the  scoliosis  is  directed 
they  are  raised,  while  the  other  is  lowered. 

Palpation  of  Various  Vertebrae 

Palpation  of  the  Atlas. — The  first  vertel)ra  to  be  considered 
is  the  atlas  and  its  articulation  with  the  occipital  bone.  Sub- 
luxation of  this  joint  is  very  common,  and  at  the  same  time 
of  much  importance  by  reason  of  its  close  proximity  to  the 
base  of  the  nerve  supply  since  the  slightest  displacement  at 
this  joint  produces  a  disturbance  in  the  innervation  of  the 
brain  substance  itself. 

The  condyles  of  the  occipital  bone  are  kidney-shaped,  and 
convex  antero-posteriorly,  their  posterior  edge  extending  to 
about  the  middle  of  the  foramen  magnum  and  following  the 
margin  of  the  foramen  for  about  one-sixth  of  its  circumfer- 
ence, thus  forming  practically  a  centre  of  gravity  on  which 
to  support  the  head.  The  articular  surfaces  on  the  lateral 
masses  of  the  atlas  are  concave  in  the  same  direction  that  the 
condyles  are  convex,  thus  forming  a  U-shaped  articulation 
from  before  backward,  and  constituting  a  perfect  hinge-joint. 
Laterally,  however,  there  is  but  limited  motion.  The  same 
restrictions  apply  to  rotation,  yet  there  is  sufificient  motion 
possible  to  permit  the  occurrence  of  all  the  primary  forms  of 
subluxation. 

The  anterior,  posterior,  and  lateral  ligaments  are  mainly 
depended  upon  for  the  maintenance  of  the  approximation  of 
the  surfaces  of  the  bones  forming  this  articulation,  as  the 
capsular  ligaments  are  very  loose.  An  anterior  displacement 
of  the  occiput  will  be  shown  by  a  forward  position  of  the 
chin.  The  production  of  this  form  of  displacement  is  favored 
by  irritation  of  the  nerves  which  supply  the  sterno-mastoid 
and  trapezius  muscles,  contraction  of  these  muscles  following. 


304  SPINAL  ADJUSTMENT 

There  are  also  cases  in  which  the  jugular  processes  of  the 
occipital  bone  and  the  mastoid  processes  of  the  temporal  bone 
are  ankylosed.  Sometimes  the  atlas  is  ankylosed  to  the 
occiput,  either  entirely  or  in  part,  as  a  result  of  a  destruction 
of  the  joint  or  to  a  faulty  development  of  the  atlas ;  in  the 
latter  instance  the  condition  is  congenital  and  cannot  be  cor- 
rected. Such  conditions  are  to  be  suspected  when  the  subject 
is  unable  to  execute  the  nodding  movements  of  the  head  and 
making  lateral  movements.  Abnormalities  of  this  kind  should 
only  be  adjusted  after  a  very  careful  examination  has  been 
made,  as  should  the  ankylosis  involve  the  entire  margin  of  the 
foramen  and  the  anterior,  posterior  and  lateral  ligaments,  we 
would  question  the  advisability  of  breaking  this  union,  be- 
cause the  most  vital  part  of  the  spinal  cord  is  encircled  by 
this  articulation.  It  must  always  be  borne  in  mind  that  the 
ligaments  of  a  joint  are  the  real  means  of  restraint  of  its 
movements,  and  it  can  therefore  readily  be  seen  what  would 
occur  in  such  a  case  as  the  above  were  the  ligaments  broken. 
The  integrity  of  the  joint  would  then  depend  upon  the  con- 
traction of  the  muscles  involved  in  the  movements  of  the 
joint;  in  this  case  a  complete  dislocation  would  likely  develop 
with  compression  of  the  medulla.  Any  form  of  subluxation 
of  this  joint  will  disturb  the  circulation  and  irritate  the  nerves 
of  the  brain  and  scalp. 

The  diagnosis  of  subluxation  of  the  occipito-atlantal  articu- 
lation is  fortunately  quite  easy,  as  the  body  of  the  atlas  is 
represented  by  the  lateral  masses,  which  set  practically  to  the 
edge  of  the  transverse  processes  of  the  other  cervical  ver- 
tebrae; since  they  are  also  placed  just  below  the  mastoid 
processes,  the  latter  are  taken  as  a  guide  to  the  detection  and 
determination  of  subluxations  of  the  atlas.  Normally,  both 
transverse  processes  should  be  equi-distant  from  the  adjacent 
mastoid  process.  If  one  side  presents  a  greater  depression 
between  the  transverse  process  and  the  corresponding  mastoid 
process  than  the  other,  a  subluxation  should  be  suspected.  It 
is,  however,  not  uncommon  for  one  transverse  process  to  be 
more  fully  developed  than  the  other ;  hence  to  avoid 
mistaking  an  overgrowth  of  bone  for  a  subluxation, 
further  comparisons  must  be  made.  Note  whether  or 
not   the   posterior   tubercle   of   the   atlas   corresponds   to   the 


SPINAL  ANALYSIS  305, 

center  of  the  occiput;  then  follow  the  posterior  arch  of  the 
atlas  around  to  the  front  and  ascertain  if  they  correspond  in 
prominence  laterally  and  posteriorly  to  the  corresponding 
surfaces  of  the  occiput,  bearing  in  mind  the  different  forms 
of  subluxations  possible.  Attention  must  also  be  given  the 
fact  that  any  turn  of  the  head,  if  the  articulation  is  normal, 
will  change  the  relation  of  the  transverse  processes  to  the 
various  points  of  comparison.  If,  further,  the  extreme  move- 
ments of  the  joint  can  be  executed  without  any  sense  of  pain 
or  discomfort,  no  subluxation  exists.  The  muscles  and  liga- 
ments immediately  adjacent  to  the  joint  on  the  side  on  which 
the  nerve  is  impinged  are  contracted.  By  pressing  the  index 
fingers  up  close  to  the  occiput  the  subject  will  experience 
considerable  tenderness.  This  tenderness  is  similar  to  that 
produced  when  the  posterior  branch  of  the  spinal  nerve  is 
pressed  upon  in  other  regions  of  the  spine.  The  recurrent 
branch  to  the  meninges  and  the  body  of  the  vertebra  arises 
by  two  roots,  one  from  the  spinal  and  the  other  from  the 
sympathetic  ganglion.  The  operator's  fingers  do  not  come 
into  direct  contact  with  this  nerve  as  it  is  usually  well  pro- 
tected by  the  jaw  and  the  mastoid  process ;  it  is  the  posterior 
muscular  nerve  which  branches  from  the  same  nerve  that  im- 
parts the  sensation.  Pressure  upon  this  nerve  produces  vaso- 
motor disturbances  within  the  cord  as  well  as  in  the  meninges 
and  bone. 

In  an  occipito-atlantal  subluxation  the  superior  cervical 
ganglion  is  compressed  by  the  transverse  process  and  vaso- 
motor changes  in  the  vessels  of  the  brain,  eyes,  and  meninges 
result.    Anemia  or  hyperemia  of  the  brain  will  follow. 

In  a  posterior  displacement  of  the  occiput  on  the  atlas  the 
same  general  rules  must  be  followed,  in  fact  this  must  be  done 
in  all  cases  regardless  of  the  location  of  the  displacement. 
The  main  points  of  comparison  are  the  transverse  processes 
of  the  atlas  with  the  mastoid  processes,  and  the  posterior 
tubercle  of  the  atlas  with  the  external  occipital  protuberance. 

In  making  an  examination  for  an  occipital  displacement 
the  relation  of  the  atlas  to  the  axis  must  also  be  determined, 
as  in  such  a  subluxation  there  will  be  some  displacement  of 
the  suspensory  and  check  ligaments  which  connect  the  axis 
with  the  occiput.     There  will  also  be  present  the  same  con- 


306 


SPINAL  ADJUSTMENT 


Fig.  58. 
Palpation  of  Cervical   Vertebrae. 


SPINAL  ANALYSIS  307 

traction  of  the  ligaments  which  unite  the  atlas  and  the  occipital 
bone  as  are  found  in  other  regions  of  the  spine  when  the 
laminae  are  palpated.  The  unilateral  contraction  of  these 
ligaments  is  readily  determined. 

It  must  be  remembered  further  that  the  cartilage  which 
separates  the  atlas  from  the  occipital  bone  and  from  the  axis 
resembles  hyaline  cartilage,  and  is  not  of  the  same  fibro- 
cartilaginous quality  as  is  that  which  composes  the  discs 
which  are  placed  between  the  other  vertebrae.  In  case  of 
tilting  or  any  displacements  in  which  a  space  is  left  between 
the  articular  surfaces,  the  cartilage  may  thicken  and  when 
this  occurs  the  displacement  will  resist  correction  for  a  greater 
length  of  time. 

In  a  lateral  displacement  it  will  be  found  that  the  trans- 
verse process  on  the  side  which  is  displaced  downward  is 
nearer  the  mastoid  process,  while  on  the  opposite  side  a  space 
greater  than  normal  exists. 

In  a  rotary  subluxation  of  this  joint  the  atlas  is  involved, 
and  the  superior  cervical  ganglion  is  influenced  as  a  result  of 
the  continuous  compression  of  the  spinal  nerves  which  com- 
municate with  it.  This  form  of  subluxation  is  brought  about 
by  a  unilateral  contracted  condition  of  the  rectus  capitis 
anticus  minor  muscle  which  normally  produces  rotation,  since 
it  arises  from  the  anterior  surface  of  the  lateral  mass  and  the 
root  of  the  transverse  process  of  the  atlas,  and,  passing 
upward  and  inward,  is  inserted  into  the  basilar  process  of 
the  occipital  bone.  Its  proximity  to  the  cervical  ganglion 
will  cause  it  to  press  upon  this  structure  when  it  is  con- 
tract'ed. 

In  palpating  atlas  displacements  the  peculiar  construction 
of  the  atlas  and  its  association  with  the  axis  should  be  kept 
in  mind.  There  is  always  sufficient  space  laterally  between 
the  odontoid  process  and  the  lateral  margins  of  the  anterior 
arch  of  the  atlas  to  admit  of  a  lateral  displacement  great 
enough  to  produce  serious  results.  Usually,  however,  the 
greatest  lateral  displacements  at  the  occipito-atlantal  joint 
are  due  to  a  slipping  of  the  condyles  upon  the  atlas,  and  not 
of  the  atlas  itself  upon  the  condyles.  When  the  atlas  is  in- 
volved mostly,  there  will  usually  be  also  rotation. 

Tilting  forward  of  the  atlas  is  also  a  serious  form  of  dis- 


308 


SPINAL  ADJUSTMENT 


^ 


f    ,    P 


D 


lo      (     P 


" 

IM 

" 

N 

'  l^\ 

- 

( 

3 

'     r. 

t 

^ 

\     ^ 

-     / 

Fig.  59. 
Spinal  Analysis  Chart. 


SPINAL  ANALYSIS  309 

placement,  and  distinction  must  be  made  between  a  tilting 
of  the  occiput  and  that  of  the  atlas.  A  tilting  downward  and 
forward  of  the  occiput  is  limited  by  the  posterior  arch 
of  the  atlas;  but  a  tilting  downward  and  forward  of  the 
atlas  may  occur  without  any  displacement  of  the  occiput; 
such  a  subluxation  is  made  possible  by  a  laxness  of  the 
transverse  ligament,  or  by  a  persistent  contraction  of  the 
anterior  ligaments.  A  lack  of  tone  in  the  sterno-mastoid 
or  upper  part  of  the  trapezius  muscles  will  also  predispose  to 
the  production  of  this  form  of  subluxation.  The  same  com- 
parison must  be  made  as  when  the  occiput  is  palpated.  The 
relation  of  the  transverse  processes  to  the  mastoid  processes 
and  to  the  transverse  processes  of  the  other  cervical  vertebrae 
should  be  determined.  The  posterior  arch  should  be  palpated 
in  relation  with  the  spinous  process  and  laminae  of  the  axis. 
Rotation  is  usually  associated  with  atlas  displacements  and 
is  indicated  by  a  fullness  on  the  side  to  which  the  subluxation 
is  inclined.  This  is  readily  determined  by  palpation,  and  cor- 
responds to  the  method  of  palpating  the  other  vertebrae  ex- 
cept that  in  this  instance  the  posterior  arch  instead  of  the 
transverse  processes  and  laminae  is  palpated. 

Palpation  of  the  Axis. — The  most  common  form  of  sub- 
luxation of  the  axis  is  the  rotary.  Lateral  displacement  when 
present  produces  the  greatest  degree  of  irritation  and  con- 
gestion, as  a  result  of  pressure  upon  the  nerves  and  blood- 
vessels emerging  from  the  intervertebral  foramina  between 
the  axis  and  third  cervical  vertebra.  The  manner  of  de- 
termining subluxations  of  the  axis  is  the  same  as  that  em- 
ployed in  the  examination  of  the  other  cervical  vertebrae. 
The  patient  should  be  in  the  dorsal  position.  The  spinous 
process  of  the  axis  is  then  located,  and  the  laminae  are  fol- 
lowed forward  until  the  tips  of  the  transverse  processes  are 
reached ;  these  are  then  compared  with  those  of  the  atlas  and 
the  third  cervical  vertebra.  In  this  way  lateral,  rotary,  supero- 
inferior,  compression  and  scoliotic  subluxations  of  this  ver- 
tebra will  be  easily  detected.  Kyphosis  and  lordosis  can  be 
detected  by  inspection. 

Palpation  of  the  Other  Cervical  Vertebrae, — Subluxations 
of  the  cervical  vertebrae  can  be  detected  in  the  same  way  as 
that  just  described  under  palpation  of  the  axis.     There  will 


310  SPINAL  ADJUSTMENT 

.—»        Cot^)/>r^^''i  on 


Lotbot'it^ 


^Co"iie"bl<i. 


F  ig.  60. 
Signs  Showing  Various  Sul)luxations. 


SPINAL  ANALYSIS  311 

be,  however,  a  slight  difference  imparted  to  the  touch  by 
reason  of  the  fact  that  in  the  axis  the  transverse  processes 
spring  from  the  base  of  the  inferior  articular  processes,  and 
owing  to  the  absence  of  the  costal  process  in  this  vertebra 
the  groove  between  the  costal  and  transverse  processes  is 
lacking;  this  difference  is,  however,  of  no  practical  importance. 
(Fig.  58.)^ 

Palpation  of  the  Thoracic  Vertebrae. — In  palpating  the 
thoracic  vertebrae  one  must  not  be  misled  by  the  position  of 
the  spinous  processes,  since,  as  previously  mentioned,  their 
angle  of  direction  with  the  body  of  the  vertebrae  may  be  ab- 
normal. Such  an  error  may  be  avoided  by  palpating  the 
transverse  processes,  and  also  noting  the  presence  or  absence 
of  other  signs  of  subluxation,  as  contracted  ligaments,  hyper- 
aesthesia,  and  increased  temperature. 

The  spinous  processes  of  the  upper  thoracic  vertebrae  are 
longer  than  those  of  the  lower,  and  therefore  extend  down- 
.ward  much  farther  from  a  line  drawn  horizontally  through 
the  transverse  processes.  This  downward  direction  of  the 
spinous  processes  of  these  vertebrae  must  be  borne  in  mind 
in  palpation ;  usually  the  transverse  processes  of  a  vertebra 
the  spinous  process  of  wdiich  has  just  been  palpated  are 
situated  at  the  level  of  the  spinous  process  of  the  vertebra 
above. 

Another  point  to  be  remembered  is  that  the  transverse 
processes  should  follow  gradually  an  oblique  line  from  the 
upper  thoracic  vertebrae  inward  tow^ard  the  spinous  process  of 
the  twelfth  thoracic  vertebra.  This  line  is  formed  by  the  grad- 
ual decrease  in  length  of  the  transverse  processes  from  the  first 
to  the  twelfth.  The  transverse  processes  of  the  twelfth  tho- 
racic are  usually  very  rudimentary,  being  merely  a  tubercle 
projecting  backward  and  outward  from  the  junction  of  the 
articular  processes  with  the  pedicles.  The  tenth  thoracic  also 
sometimes  possesses  such  a  rudimentary  transverse  process, 
from  the  upper  surface  of  which  a  prominent  tubercle  projects 
toward  the  spinous  process  of  the  vertebra  above,  as  normally 
occurs  on  the  twelfth  thoracic  vertebra.  This  tubercle  is  just 
posterior  to  the  superior  articular  process,  and  may  be  present 
on  the  tenth,  eleventh,  or  twelfth  thoracic  vertebra,  according 
to  which  is  the  transitional  one. 


312 


SPINAL  ADJUSTMENT 


7 


■> 


X 


L(       ^4*    0 


r 


Z'' 


7^ 


X 


Fig.  61. 
Record  of  Spinal  Analysis. 


SPINAL  ANALYSIS  313 

Palpation  of  the  Lumbar  Vertebrae. — By  examining  the 
lumbar  vertebrae  the  transverse  processes  will  be  seen  to  ex- 
tend laterally  and  backward,  while  the  articular  processes 
project  posteriorly.  Palpation  of  the  vertebrae  in  this  region 
of  the  spine  will  be  easy  if  the  operator  keeps  in  mind  the 
characteristics  of  each  vertebra.  The  transition  from  the 
lumbar  to  the  sacral  type  will  be  noted  from  the  fact  that  the 
inferior  articular  processes  are  much  farther  apart  in  the  fifth 
than  in  the  fourth  vertebra.  In  palpating  the  vertebrae  of  the 
lumbar  region,  test  for  ankylosis  between  the  fifth  lumbar 
vertebra  and  the  sacrum,  and  also  remember  the  possibility 
of  an  individual  first  sacral  vertebra. 

The  X-ray  in  the  Diagnosis  of  Subluxations. — In  the  de- 
termination of  subluxations  the  X-ray  is  of  great  utility,  and 
should  be  used  whenever  doubt  exists  as  to  the  real  nature  of 
the  displacement.  The  technique  of  the  use  of  the  X-ray 
cannot  be  given  in  a  work  of  this  kind,  but  the  operator  can 
become  familiar  with  this  by  referring  to  any  standard  book 
on  electro-therapeutics.  . 

Method  of  Using  the  Spinal  Analysis  Chart. — Having  made 
a  careful  spinal  analysis,  the  operator  should  next  make  a 
record  of  the  findings.  For  this  purpose  a  suitable  chart  is 
used  and  certain  signs  are  used  to  indicate  the  nature  of  the 
subluxations  found  in  the  different  segments  of  the  vertebral 
column. 

The  chart  to  be  used  for  recording  the  different  subluxa- 
tions is  shown  in  Fig.  59.  The  signs  to  be  used  are  illustrated 
in  Fig.  60.  A  specimen  chart  showing  the  record  of  a  spinal 
analysis  is  shown  in  Fig.  61. 

Each  time  that  the  patient  presents  himself  for  a  treatment, 
however,  the  spine  should  be  carefully  examined,  to  determine 
any  changes  which  have  occurred  in  the  interim. 

The  use  of  specific  adjustments  for  certain  conditions  has 
passed.  For  example,  it  was  formerly  the  custom  when  a 
patient  sufifered  from  a  group  of  symptoms  indicating  kidney 
disease  to  adjust  the  10th  dorsal  vertebra,  which  was  styled 
"Kidney  Place"  or,  abbreviated,  K.  P.  Such  a  method  is  very 
unscientific  since  we  find  very  often  that  kidney  disease  may 
exist  when  other  diseased  conditions  are  present,  and  it  is 
only  by  correcting  these  conditions  that  the  kidney  trouble 


314  SPINAL  AnjUSTMENT 

will  be  relieved.  For  example,  in  valvular  disease  of  the 
heart  one  often  meets  with  congestion  of  the  kidneys  and  even 
a  slight  albuminuria  is  present;  evidently  adjustment  of  the 
tenth  dorsal  vertebra  in  such  a  case  will  not  relieve  the  kid- 
ney trouble,  since  so  long  as  the  heart  is  affected  the  kidney 
will  also  be  abnormal. 

A  further  reason  that  specific  subluxations  are  unscientific 
and  ineffective  is  that  nearly  every  spinal  segment  affects  or 
controls  different  organs  even  though  they  more  particularly 
influence  a  certain  part  of  the  body.  Accordingly  the  tenth 
dorsal  vertebra  may  be  subluxated  and  other  diseases  than 
kidney  disease  result. 

Still  another  reason  that  such  a  method  cannot  be  used 
with  certainty  is  that  different  spinal  segments  control  one 
and  the  same  organ.  We  accordingly  find  that  in  all  cases  of 
kidney  disease  the  tenth  dorsal  vertebra  is  not  necessarily 
affected,  but  the  subluxation  may  be  of  the  eleventh  or  twelfth 
dorsal. 

The  only  proper  method  to  follow,  therefore,  is  to  make 
a  general  examination  of  each  patient  to  determine  if  pos- 
sible what  part,  organ  or  system  of  the  body  is  affected.  The 
special  examination  of  the  patient  should  then  be  made  for 
the  purpose  of  determining  exactly  how  this  part  is  affected. 
This  should  be  followed  by  the  spinal  analysis,  the  findings  of 
which  should  be  recorded  in  the  manner  above  illustrated, 
which  will  show  which  vertebra  is  subluxated  and  the  nature 
of  the  subluxation.  The  operator  is  then  prepared  to  make 
the  proper  adjustment  of  the  vertebral  displacement,  as  will 
be  shown  in  the  next  section. 


SECTION    SIX 

Spinal  Adjustment 


CHAPTER  I 
General   Considerations 

Briefly  defined,  spinal  adjustment  is  the  replacement  to 
their  normal  position  of  snbluxated  vertebrae  for  the  purpose 
of  relieving  pressure  upon  the  nerves,  and  thus  restoring  to 
the  parts  supplied  by  these  nerves  their  proper  innervation. 

This  replacement  of  subluxated  vertebrae  is  accomplished 
by  the  application  of  a  definite  thrust  by  the  hands  of  the 
operator  in  contact  with  the  affected  vertebra. 

Spinal  adjustment  must  not  be  considered  as  the  pushing 
of  a  vertebra  back,  so  to  speak,  to  its  proper  position,  as  that 
is  not  the  primary  effect  of  the  thrust  v^hich  is  applied  to  the 
vertebra.  The  immediate  effect  of  the  thrust  upon  the  ver- 
tebra is  a  momentary  relaxation  of  the  ligaments  of  one  side 
permitting  the  ligaments  of  the  opposite  side  which  had  been 
stretched  beyond  the  limit  of  their  elasticity  to  return  to  their 
original  condition. 

To  overcome  the  contraction  of  the  ligaments  which  are 
drawing  the  displaced  vertebra  out  of  alignmeitt  the  thrust 
must  be  spontaneous,  and  be  applied  at  the  moment  of  most 
complete  relaxation  of  the  patient.  A  slow,  continuous  pres- 
sure, regardless  of  how  heavy  it  might  be,  will  not  accomplish 
the  desired  eft'ect ;  on  the  contrary,  it  will  tend  to  aggravate 
the  contraction  of  the  ligaments.  A  familiar  example  at  this 
point  will  serve  to  make  clear  this  important  phase  of  spinal 
adjustment.  We  are  all  familiar  with  the  cramp  of  the  plantar 
muscles,  and  have  observed  how  this  cramp  draws  the  bones 
of  the  foot  in  various  directions.  A  sudden  blow  upon  the 
contracted  muscles  brings  instant  relief  by  causing  the  muscles 
to  relax,  which  permits  the  bones  of  the  foot  to  return  to  their 

315 


316  SPINAL  ADJUSTMENT 

normal  position.  This  is  exactly  what  occurs  in  the  vertebral 
column ;  a  certain  ligament  is  contracted  and  draws  the  ver- 
tebra with  which  it  is  connected  out  of  alignment ;  the  spon- 
taneity of  the  thrust  causes  the  contracted  ligament  to  be- 
come relaxed,  and  the  vertebra  returns  to  its  normal  position. 
The  first  prerequisite  to  successful  spinal  adjustment,  there- 
fore, is  that  the  thrust  be  spontaneous.  This  spontaneity  is 
well  illustrated  by  the  sharp,  quick  blow  of  a  hammer  upon  a 
hard  surface,  like  an  anvil.  The  rebound  of  the  hammer  is 
caused  by  the  rapidity  of  the  stroke  rather  than  by  the  strength 
or  continuity  of  the  force  applied.  Another  and  still  better 
illustration  may  be  given  by  taking  a  pile  of  individual  blocks : 
A  sharp,  quick  blow  against  one  of  the  blocks  will  move  the 
individual  block  against  which  the  stroke  is  directed  without 
affecting  the  pile  as  a  whole,  whereas  steady  pressure,  lack- 
ing the  spontaneity  referred  to,  would  simply  push  over  the 
entire  column  or  pile  of  blocks. 

In  the  application  of  the  thrust  no  great  expenditure  of 
force  is  required.  William  Jay  Dana,  B.  S.,  says  in  respect 
to  this  that,  "It  can  be  easily  shown  mathematically  that  if  a 
spine  can  stand  a  tension  of  750  pounds,  it  would  only  take  a 
blow  with  a  velocity  of  five  feet  a  second,  given  by  a  man 
who  could  put  ten  pounds  of  his  weight  behind  his  adjustment, 
in  order  to  move  a  vertebra  one-sixteenth  of  an  inch.  This 
kind  of  a  blow  is  obviously  within  the  capacity  of  any  aver- 
age man." 

How  replacement  of  the  vertebra  occurs  is  also  very  ac- 
curately explained  by  Dana,  as  follows:  "Mechanical  shear- 
ing occurs  when  two  equal  and  opposite  forces  act  at  right 
angles  to  a  bar.  When  tension  is  transmitted  through  two 
overlapping  boiler  plates  riveted  together,  the  first  eft'ect  is 
a  sidewise  compression  on  the  rivets,  tending  to  cut  them  off. 
To  move  one  vertebra  with  respect  to  another,  shearing  forces 
must  be  used.  The  intervertebral  cartilaginous  disc  must  be 
sheared  to  produce  an  actual  molecular  displacement  or  separa- 
tion. The  high  speed  adjustment  accomplishes  this,  separating 
the  vertebrae,  and  relieving  the  pressure  at  the  foramina.  An 
adjustment  causes  a  slight  injury;  hence  an  increased 
metabolism  of  the  surrounding  tissues ;  the  blood  is  rushed 
to  the  tissues  for  reparative  purposes,  compressed  cartilages 


GENERAL  CONSIDERATIONS  317 

are  built  up,  thereby  relieving  the  pressure  exerted  by  the 
previously  approximated  vertebrae." 

To  obtain  the  greatest  degree  of  spontaneity  in  giving  the 
thrust  several  things  must  be  observed. 

The  first  of  these  relates  to  the  manner  of  delivering  the 
thrust.  On  having  determined  the  exact  nature  of  the  sub- 
luxation, the  operator  places  the  proper  contact  point  of  the 
hand  on  the  desired  point  of  the  vertebra  to  be  adjusted.  A 
firm  degree  of  pressure  should  exist  at  the  contact  point,  and 
should  not  be  increased  or  diminished  during  the  delivery  of 
the  thrust.  The  operator  should  stand  near  to  and  directly 
over  the  patient  so  that  the  arms  are  perfectly  perpendicular 
to  the  patient's  back.  The  arms  should  be  held  rigid,  with  the 
elbows  locked.  The  shoulders  are  then  raised  to  the  greatest 
degree  consistent  with  the  maintenance  of  the  desired  pres- 
sure on  the  spine  at  the  contact  points.  The  thrust  is  then 
delivered  by  a  quick  downward  movement  of  the  shoulders, 
arms  and  back,  with  the  hip-joint  as  an  axis.  As  soon  as  the 
thrust  has  been  made  the  hands  should  be  removed  from  the 
back.  The  thrust  should  be  made  as  soon  as  the  correct 
contact  with  the  vertebra  to  be  adjusted  has  been  applied, 
since  any  delay  in  executing  the  thrust  permits  contraction 
of  the  spinal  musculature  from  apprehension  on  the  part  of 
the  patient.  The  precise  direction  of  the  movement  is  gov- 
erned by  the  nature  of  the  subluxation  and  the  region  of  the 
spine  in  which  it  is  located. 

The  second  essential  to  the  proper  delivery  of  the  thrust 
relates  to  the  operator's  position.  The  object  and  importance 
of  a  correct  position  for  the  delivery  of  the  thrust  should  be 
constantly  borne  in  mind.  Unless  perfect  poise  is  secured  and 
maintained,  the  operator  will  not  be  able  to  accumulate  the 
force  necessary  to  deliver  the  thrust  at  the  right  time  and  in 
the  right  direction.  The  prime  essential  to  the  success  of  the 
thrust,  namely  that  it  be  spontaneous,  can  only  be  secured 
when  the  operator  is  perfectly  poised.  This  poise  enables 
him  to  be  in  a  state  of  readiness  to  take  advantage  of  the 
momentary  relaxation  of  the  patient,  which  is  most  apparent 
at  the  end  of  expiration.  It  also  enables  the  operator  to  feign 
a  thrust  in  a  very  sensitive  or  hysterical  patient.  This  is 
done  by  pressing  down  on  the  patient's  back,  and  making  a 


318  SPINAL  ADJUSTMENT 

short,  mild  thrust,  followed  by  one  of  greater  force  at  the 
moment  of  relaxation  on  the  part  of  the  patient  from  the  first 
thrust.  It  also  permits  of  delivery  of  the  thrust  at  the  proper 
angle.  The  poise  should  be  such  as  will  enable  the  force  to 
be  carried  downward  equally  along  each  arm  to  the  point  of 
contact,  when  a  double  hold  is  employed.  When  a  single 
hold  is  used,  the  force  is  carried  along  the  arm  which  applies 
the  thrust,  and  in  the  direction  which  is  necessary  for  the 
correction  of  the  subluxation.  Lastly  the  proper  poise  is  of 
importance  since  it  permits  the  thrust  to  be  given  without 
the  slightest  discomfort  to  the  patient,  and  with  the  greatest 
ease  to  the  operator. 

The  third  requisite  to  the  successful  delivery  of  the  thrust 
is  that  it  be  applied  at  the  moment  of  extreme  relaxation  of 
the  patient.  It  will  be  found  in  this  connection  that  the  best 
rule  to  follow  will  be  to  deliver  the  thrust  as  soon  as  the 
proper  contact  with  the  vertebra  to  be  adjusted  has  been 
made,  and  before  any  contraction  of  the  muscles  of  the 
patient's  back,  due  to  apprehension  on  his  part,  has  had  time 
to  develop.  If,  however,  the  patient  continuously  contracts 
the  muscles,  a  feint  thrust,  immediately  followed  by  one  of 
greater  force,  should  be  given,  since  after  the  milder  thrust 
there  occurs  a  period  of  momentary  relaxation.  If  even  this 
is  unsuccessful,  the  operator  should  wait  until  the  patient  is 
breathing  naturally,  and  then  apply  the  thrust  at  the  point 
of  extreme  exhalation.  One  of  these  methods  will  enable  the 
thrust  to  be  successfully  delivered.  In  any  event,  however, 
it  is  advisable  to  instruct  the  patient  in  regard  to  the  neces- 
sity of  perfect  relaxation  on  his  part,  and  this  may  be  acquired 
by  his  own  volition.  If  an  adjustment  is  made  in  spite  of 
the  fact  that  the  patient  is  not  completely  relaxed,  consider- 
able soreness  at  the  point  over  which  the  thrust  is  made  will 
be  experienced  for  some  time.  Every  means  should  therefore 
be  employed  to  secure  perfect  relaxation  of  the  patient  before 
the  thrust  is  applied,  and  one  of  the  above  methods  will  always 
suffice  to  produce  this. 

Equal  in  importance  with  the  manner  of  delivering  the 
thrust  is  the  mode  of  contact  of  the  operator's  hand  with  the 
vertebra  to  be  adjusted,  which  in  chiropractic  terminology  is 
known  as  the  "Hold."    The  reader  will  note  in  future  chapters 


GENERAL  CONSIDERATIONS  319 

that  these  holds  are  not  all  in  direct  connection  with  the 
vertebral  column.  It  may  be  said,  however,  that  whenever  a 
specific  vertebra  is  to  be  adjusted,  the  hands  should  be  in 
contact  with  the  vertebra  itself.  In  the  giving  of  the  thrust 
the  spinous  or  transverse  processes  are  used  as  levers,  while 
the  force  which  acts  through  these  levers  to  produce  a  move- 
ment of  the  vertebra  as  a  whole  is  applied  by  the  contact  hand. 
There  are  in  vogue  among  Chiropractors  a  great  variety  of 
holds,  since  nearly  every  operator  favors  some  particular  form 
of  contact  which  he  uses  almost  exclusively  in  all  regions  of 
the  spine,  with  slight  variations.  There  thus  appear  in  this 
work  holds  which  are  highly  endorsed  by  some  and  which 
are  equally  condemned  by  other  Chiropractors.  However,  it 
is  our  opinion  that  not  one  of  the  holds  mentioned  is  entirely 
devoid  of  some  merit.  In  general  the  operator  will  find  that  a 
few  holds  will  suffice ;  there  are,  however,  cases  in  which  none 
of  the  commonly  used  holds  will  serve  to  produce  the  desired 
effect,  and  it  becomes  necessary  to  use  a  hold  which,  though 
it  is  seldom  resorted  to,  still  has  a  place  in  just  this  class  of 
cases.  In  the  descriptions  of  the  various  holds  those  having 
the  greatest  range  of  usefulness  are  therefore  placed  first; 
if  it  is  found,  as  occasionally  happens,  that  one  of  these  holds 
will  not  produce  the  adjustment,  one  of  the  others  should 
be  employed. 

In  the  great  majority  of  cases  it  will  be  found  that  contact 
with  the  transverse  processes  is  much  to  be  preferred  to  that 
with  the  spinous  processes.  The  reasons  for  this  are  obvious 
to  any  one  who  uses  both  methods  for  a  time,  and  compares 
the  effects  of  each.  Chief  among  the  reasons  why  the  use  of 
the  transverse  processes  as  levers  is  preferable  is  the  fact  that 
the  force  can  be  directed  with  greater  accuracy.  Some  chiro- 
practors disregard  the  transverse  processes  entirely,  even  in 
palpation,  and  therefore  also  in  adjustment,  and  limit  them- 
selves to  the  spinous  processes  exclusively.  From  what  has 
been  said  in  preceding  chapters  the  reader  must  appreciate 
that  such  methods  must  fail  in  some  instances.  Another  im- 
portant reason  for  using  the  transverse  processes  rather  than 
the  spinous  wherever  possible  is  that  by  using  the  former 
as  levers  the  possibility  of  producing  soreness  following  the 
adjustment  is  greatly  minimized. 


320 


SPINAL  ADJUSTMENT 


Fig.  62. 

Showing  the  Contact  Points 
on  the  Hand. 


GENERAL  CONSIDERATIONS  321 

The  final  essential  to  the  proper  delivery  of  the  thrust  is 
the  point  of  contact  of  the  operator's  hand.  Fii^.  62  illustrates 
these  points  which  are  named  as  follows: 

1.  The  Calcanear  contact. 

2.  The  Pisiform  contact. 

3.  The  Hypothenar  contact. 

4.  The  Thenar  contact. 

5.  The  Thumb  contact. 

The  indications  for  the  use  of  each  of  these  various  forms 
of  contact  are  given  under  the  various  holds  described  in  the 
following  chapters. 


CHAPTER  II 

Adjustment  of  the  Cervical  Vertebrae 

The  Temporo-Transverse  Hold. — Indications. — This  hold 
is  the  best  for  general  use  in  the  cervical  region.  It  lacks  en- 
tirely the  element  of  harshness  present  in  other  holds  used 
for  adjustment  of  the  vertebrae  in  this  region.  It  is  especially- 
adapted  to  correction  of  lateral,  rotary,  scoliotic,  and  supero- 
inferior  subluxations. 

Position  of  the  patient. — The  patient  should  be  in  the 
dorsal  position. 

Points  of  contact. — The  head  of  the  patient  rests  in  one 
hand  of  the  operator,  while  the  thenar  eminence  of  the  other 
hand  is  placed  against  the  transverse  process.  In  rotary 
subluxations  the  contact  is  with  the  posterior  surface  of  the 
transverse  process  which  is  posterior;  in  lateral  subluxations 
the  contact  is  on  the  union  of  the  transverse  and  costal  proc- 
esses which  are  displaced  away  from  the  line  of  the  spinous 
processes ;  in  supero-inferior  subluxations  the  contact  is  with 
the  inferior  surface  of  the  transverse  process  of  the  side  of  the 
vertebra  which  is  displaced  downward;  in  scoliosis  each  ver- 
tebra should  be  separately  adjusted  as  rotary  or  lateral  sub- 
luxations, in  addition  to  which  the  parieto-transverse  and 
fronto-transverse  holds,  together  with  traction,  should  be  em- 
ployed. The  thumb  of  the  hand  in  contact  with  the  vertebra 
should  be  supported  on  the  side  of  the  patient's  lower  jaw. 

Method  of  delivery. — The  head  is  raised,  with  the  patient's 
face  turned  away  from  the  contact  hand,  and  flexed  in  the 
direction  of  the  hand  in  contact  with  the  vertebra  to  be  ad- 
justed. When  completely  flexed,  a  spontaneous  thrust  is  made 
against  the  transverse  process  at  the  same  time  that  the  head 
is  brought  in  the  direction  of  the  contact  hand.  The  direction 
of  the  thrust  depends  upon  the  nature  of  the  subluxation, 
namely  in  the  direction  that  will  place  the  vertebra  in  proper 
alignment. 

This  hold  is  illustrated  in  Figs.  63  and  64. 

322 


CERVICAL  VERTEBRAE 


323 


Fig.  63. 

Temporo-Trnnsverse  Hold. 


324 


SPINAL  ADJUSTMENT 


Fig.  64. 
Temporo-Transverse  Hold. 


CERVICAL  VERTEBRAE 


325 


Fig.  65. 
Fronto-Transverse  Hold. 


326 


SPINAL  ADJUSTMENT 


Fig.  66. 
Parieto-Transverse   Hold, 


CERViCAi-  vj:rtebrae 


327 


Fig.  67. 

Bilateral  I'isifonn-Trausvcrse 
Anterior  Hold. 


328  SPINAL  ADJUSTMENT 

The  Fronto-Transverse  Hold. — Indications. — This  is  an 
excellent  movement  in  certain  cases  of  compression  subluxa- 
tions of  the  cervical  vertebrae. 

Position  of  the  patient. — The  patient  is  in  the  dorsal  po- 
sition. 

Points  of  contact. — One  hand  is  placed  on  the  patient's 
forehead  and  the  other  just  posterior  to  the  transverse  proc- 
esses; the  four  fingers  are  used,  each  being  placed  on  the 
transverse  process  of  a  single  vertebra. 

Method  of  delivery. — In  making  the  movement,  the  hand 
on  the  forehead  is  held  firm  and  steady,  while  that  in  contact 
with  the  posterior  surface  of  the  transverse  processes  is 
drawn  up  toward  the  operator ;  at  each  such  movement  a 
different  finger  is  employed.  For  example,  if  the  index  finger 
is  in  contact  with  the  posterior  surface  of  the  transverse 
process  of  the  third  cervical,  the  first  movement  is  made  at 
this  point ;  the  next  movement  is  made  in  the  same  manner 
with  the  second  finger  in  contact  with  the  posterior  surface 
of  the  transverse  process  of  the  fourth  cervical  vertebra ;  the 
third  movement  is  the  same  with  the  third  finger  in  contact 
in  the  same  manner  with  the  fifth  vertebra  ;  and  the  fourth 
movement  with  the  finger  in  contact  with  the  sixth  vertebra. 
Repeat  the  movements  in  the  same  order  several  times.  Then 
rotate  the  head  as  shown  in  Fig.  66,  which  illustrates  the 
Parieto-Transverse  hold.  Repeat  the  movements  with  the 
hands  in  the  position  shown  in  the  Parieto-Transverse  hold, 
finishing  with  an  exaggerated  lateral  flexion  with  the  finger 
on  the  transverse  process  of  the  subluxated  vertebra.  This 
should  be  executed  in  the  same  spontaneous  manner  as 
previously  described. 

This  hold  is  illustrated  in  Figs.  65  and  66. 

The  Pisiform-Transverse  Anterior  Hold. — Indications. — 
Anterior  subluxations  of  the  cer\-ical  vertebrae. 

Position  of  patient. — The  patient  is  in  the  dorsal  position. 

Points  of  contact. — The  pisiform  processes  are  placed  on 
the  anterior  surface  of  the  transverse  processes  of  the  sub- 
luxated  vertebra.  Great  care  must  be  exercised  in  applying 
this  hold  that  the  vessels  of  the  neck  are  pushed  forward  and 
not  compressed  between  the  hands  and  the  transverse  proc- 
esses. 


CERVICAL  VERTEBRAE  329 

Method  of  delivery. — The  movement  is  straight  posteriorly, 
and  the  force  is  conveyed  equally  through  both  arms  spon- 
taneously and  with  a  downward  movement  of  the  shoulders. 
Care  should  be  taken  not  to  permit  the  hands  to  slip  when 
the  thrust  is  being  delivered. 

This  hold  is  illustrated  in  Fig.  67. 

The  Malar-Transverse  Hold. — Indications. — This  is  a 
method  for  correcting  certain  forms  of  rotary  subluxations  of 
the  cervical  group  which  will  occasionally  serve  the  operator 
to  good  advantage. 

Position  of  the  patient. — The  patient  should  be  placed  in 
the  prone  position. 

Points  of  contact. — The  thumb  is  placed  back  of  the  trans- 
verse process  which  is  posterior,  while  the  other  hand  is 
placed  on  the  side  of  the  patient's  face  over  the  malar  bone ; 
the  operator  stands  on  the  side  of  the  patient  away  from  the 
subluxated  side. 

Method  of  delivery. — The  face  of  the  patient  is  turned 
away  from  the  operator  and  the  head  raised.  A  simultaneous 
thrust  is  made  with  the  two  hands  toward  each  other.  The 
same  hold  may  be  employed  with  the  patient  in  the  erect 
position. 

This  hold  is  illustrated  in  Figs.  68  and  69. 

The  T.  M.  or  Thumb  Movement  Hold. — Indications. — This 
hold  is  very  useful  in  correcting  rotary  and  lateral  subluxa- 
tions in  the  lower  cervical  region,  and  may  be  used  in  that 
region  when  the  operator  is  unable  to  obtain  a  perfect  contact 
with  the  vertebra  to  be  adjusted  by  the  temporo-transverse 
hold. 

This  hold  is  fully  described  and  illustrated  under  adjust- 
ment of  the  thoracic  vertebrae,  q.  v. 

The  Unilateral  Pisiform-Transverse  Anterior  Hold. — In- 
dications.— In  some  instances  when  the  cervical  vertebrae,  and 
especially  the  atlas,  are  displaced  anteriorly  on  one  side,  in 
other  words  rotated,  it  rarely  becomes  necessary  to  use  this 
hold. 

Position  of  the  patient. — The  patient  should  be  in  the 
dorsal  position. 

Points  of  contact. — The  pisiform  process  of  one  hand  is 
placed  in  contact  with  the  anterior  surface  of  the  transverse 


330 


SPINAL  ADJUSTMENT 


Fig.  68. 
Malar-Transverse   Hold. 


CERVICAL  VERTEBRAE 


331 


0^ 

gl^ 

^^^^^^^^^H^^i 

^ 

1     'l 

- 

^^■jj^Hk  r 

iM 

Fig.  69. 
Malar-Transverse   HolU. 


32,2 


SPINAL  ADJUSTMENT 


Fig.  70. 
Unilateral  Pisiform-Transverse   Hold. 


CERVICAL  VF.RTF.r.RAl- 


333 


Fig.  71. 

Teinporo-Cpntruiii  Hold. 


334  SPINAL  ADJUSTMENT 

process  which  is  displaced  forward;  the  other  hand  grasps 
the  wrist  of  the  contact  hand.  In  order  to  facilitate  the  ob- 
taining of  the  proper  contact  the  patient's  face  is  turned  away 
from  the  contact  point  on  the  vertebra  to  be  adjusted. 

Method  of  delivery. — The  thrust  is  directed  directly  back- 
ward. This  relieves  the  contraction  of  the  ligaments  on  this 
side  and  permits  the  vertebra  to  return  to  its  proper  position. 
It  must  be  remembered  in  this  connection  that  when  a  ver- 
tebra is  rotated  upon  its  axis  it  may  be  due  to  a  contraction 
of  the  ligaments  of  one  side  drawing  the  corresponding  side 
of  the  vertebra  backward;  or  it  may  be  a  contraction  of  the 
ligaments  on  the  other  side  which  draws  that  side  of  the 
vertebra  forward.  In  either  case  the  vertebra  is  rotated  in 
exactly  the  same  direction,  and  only  the  contraction  of  the 
ligaments  will  serve  to  distinguish  between  them.  In  the 
latter  form  this  hold  is  therefore  necessary. 

This  hold  is  illustrated  in  Fig.  70. 

The  Temporo-Centrum  Hold. — Indications. — This  hold  is 
applicable  in  certain  cases  in  which  the  cervical  vertebrae  are 
laterally  displaced,  and  adjustment  by  other  holds  is  unsuc- 
cessful. 

Position  of  the  patient. — The  patient  is  in  the  erect  posi- 
tion, and  seated.    The  operator  stands  facing  the  patient. 

Points  of  contact. — The  thenar  eminence  of  one  hand  is 
placed  upon  the  side  of  the  body  of  the  vertebra  which  pro- 
jects beyond  that  of  the  vertebrae  above  and  below  it,  or  if 
this  is  not  feasible,  on  the  end  of  the  transverse  process  which 
projects  farthest  laterally.  The  other  hand  is  placed  upon 
the  side  of  the  patient's  head. 

Method  of  delivery. — The  patient's  head  is  turned  slightly 
away  from  the  contact  hand;  the  neck  is  then  flexed  toward 
the  side  of  the  contact  point  until  all  slack  is  taken  up.  At 
the  same  time  pressure  is  made  with  the  contact  hand  upon 
the  vertebra  to  be  adjusted.  When  the  flexion  is  complete,  the 
tension  is  momentarily  released  to  a  very  slight  degree,  and  at 
the  same  instant  a  simultaneous  thrust  of  the  hands  is  made 
toward  each  other,  the  force  of  the  thrust  made  by  the  hand 
in  contact  with  the  vertebra  being  directed  on  a  line  with  the 
transverse  processes  of  the  vertebra  being  adjusted. 

This  hold  is  illustrated  in  Fig.  71. 


CERVICAL  VERTEBRAE  335 

The  Occipito-Mandibular  Hold  A. — Indications. — This 
hold  is  useful  in  relieving  an  approximated  condition  of  the 
occipital  condyles  and  the  superior  articular  processes  of  the 
atlas,  a  form  of  compression  subluxation. 

Position  of  the  patient. — In  this  hold  the  patient  is  prone. 
The  operator  stands  at  the  patient's  head. 

Points  of  contact. — The  patient's  face  is  turned  to  the 
side.  The  operator  grasps  the  lower  jaw  with  one  hand,  and 
the  occiput  with  the  other  hand. 

Method  of  delivery. — The  neck  is  extended  as  much  as 
possible.  At  the  same  time  the  head  is  rotated  to  the  greatest 
possible  extent.  The  tension  is  then  momentarily  released, 
and  at  the  same  instant  a  spontaneous  movement  is  made. 
For  relieving  the  same  condition  on  the  opposite  side,  the 
movement  and  hold  are  reversed. 

This  hold  is  illustrated  in  Fig.  72. 

The  Occipito-Mandibular  Hold  B. — Indications. — Same  as 
above. 

Position  of  the  patient. — The  patient's  body  is  prone, 
while  the  head  is  turned  markedly.  The  operator  stands  at 
the  head  of  the  patient. 

Points  of  contact. — One  hand  grasps  the  lower  jaw,  and 
the  other  hand  the  occiput. 

Method  of  delivery. — Extension  of  the  neck  is  made  at 
the  same  time  that  the  head  is  rotated.  This  is  followed  by 
a  momentary  release  of  the  tension  thus  produced,  and  im- 
mediately thereupon  a  spontaneous  movement  of  the  hands 
is  made. 

This  hold  is  illustrated  in  Fig.  73. 

The  Occipito-Mandibular  Hold  C. — Indications. — Same  as 
above.  This  hold  is  of  advantage  in  that  it  requires  no  equip- 
ment of  any  kind,  and  often  produces  results  not  otherwise 
obtained. 

Position  of  the  patient.— The  patient  is  in  the  erect  posi- 
tion and  seated.  The  operator  stands  to  one  side  of  the 
patient. 

Points  of  contact. — One  hand  is  placed  firmly  under  the 
patient's  lower  jaw,  while  the  other  grasps  the  occiput. 


336 


SPINAL  ADJUSTMENT 


Fig.  72. 
(»((l|)itii-Mani]iluilar  Hold  A. 


CERVICAL  VERTEBRAE 


337 


Fig.  73. 
di'cijiitn  >[an(liliiil:ir   Hold   li. 


338 


SPINAL  ADJUSTMENT 


Fig.  74. 
Occipito-Mandibular  Hold  C. 


CERVICAL  VERTEBRAE 


339 


Fig.  75. 
Tempoio-Occipital   Hold. 


340  SPINAL  ADJUSTMENT 

Method  of  delivery. — Upward  traction  is  made  with  both 
hands  for  the  purpose  of  stretching  the  muscles  of  this  region. 
The  head  is  then  turned  toward  one  side.  When  the  rotation 
of  the  head  is  complete,  the  tension  is  slightly  released  and 
immediately  thereafter  a  spontaneous  movement  is  made. 
For  correcting  a  like  condition  on  the  opposite  side  the  hold 
is  reversed. 

This  hold  is  illustrated  in  Fig.  74, 

The  Temporo-Occipital  Hold. — Indications. — This  hold  is 
especially  applicable  in  cases  in  which  either  the  posterior  or 
the  anterior  arch  of  the  atlas  is  compressed  against  the  occiput. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion. 

Points  of  contact. — The  patient's  face  is  resting  on  one 
side.  One  hand  is  placed  on  the  side  of  the  patient's  face, 
while  the  other  hand  grasps  the  occiput. 

Method  of  delivery. — The  contact  having  been  obtained, 
the  thrust  is  applied  against  the  face  and  occiput  simul- 
taneously. When  the  anterior  arch  of  the  atlas  is  compressed 
against  the  occiput  the  greater  force  should  be  directed  against 
the  patient's  face ;  when  the  anterior  arch  is  compressed 
against  the  occiput,  the  greater  force  is  directed  against  the 
occiput. 

This  hold  is  illustrated  in  Fig.  75. 


CHAPTER  III 

Adjustment  of  the  Thoracic  Vertebrae 

The  Thumb-Transverse  Hold. — Indications. — This  hold  is 
principally  used  fur  adjustment  of  the  upper  thoracic  ver- 
tebrae in  delicate  patients,  women,  and  children  up  to  the 
age  of  eight  or  ten  years.  In  young  children  it  is  a  convenient 
hold  for  the  entire  thoracic  and  lumbar  regions.  It  is  used 
in  the  correction  of  posterior,  compression,  supero-inferior, 
and  rotary  subluxations. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion. The  two  sections  of  the  table  should  be  separated,  and 
care  should  be  taken  to  see  that  the  chest  should  rest  on  the 
chest-support  of  the  table.  The  operator  stands  on  the  side 
of  the  table  which  is  most  convenient  for  him  in  delivering 
the  thrust.  When  it  is  not  convenient  to  place  a  very  young 
child  upon  the  table,  the  following  contact  may  be  used :  The 
child  should  be  taken  in  the  arms  of  the  operator  so  that  its 
chest  presses  against  his  chest;  after  the  nature  of  the  sub- 
luxation has  been  determined,  a  thrust  is  made  with  the  mid- 
dle finger  in  contact  with  the  transverse  processes  of  the 
vertebra  to  be  adjusted.  Whenever  possible,  however,  the 
table  should  be  used,  and  the  thumb-transverse  hold  employed. 

Points  of  contact. — The  balls  of  the  thumbs  are  placed  on 
the  transverse  processes,  being  supported  by  the  first  and 
second  phalanges  of  the  index  finger,  which,  in  very  young 
children  rests  on  the  angle  of  the  ribs. 

Method  of  delivery. — The  contact  having  been  obtained, 
a  spontaneous  thrust  is  made.  This  will  vary  according  to 
the  nature  of  the  subluxation.  In  a  posterior  subluxation  the 
force  is  directed  downward  equally  along  each  arm ;  in  com- 
pression subluxations  the  contact  is  on  the  inferior  surface  of 
the  transverse  processes,  and  the  force  directed  toward  the 
head ;  in  a  supero-inferior  subluxation  the  thumb  is  placed 
on  the  inferior  surface  of  the  transverse  process  of  that  side 
of  the  vertebra  which  is  displaced  downward,  and  the  force 
directed  toward  the  head ;  when  in  a  supero-inferior  subluxa- 

341 


342 


SPINAL  ADJUSTMENT 


Fig.  76. 

Thumb  Transverse   Hold. 


THORACIC  VER  rEBRAK 


343 


Fig.  77. 
Crossed  Thumb-Transverse  Hold. 


344 


SPINAL  ADJUSTMENT 


Fig.  78. 
Crossed  Bilateral  Pisiforni-Transvcrse  Hold. 


THORACIC  \'Kr<l  F.F^RAi: 


345 


Fig.  79. 
Pisiforni-Spinous   Hold. 


346  SPINAL  ADJUSTMENT 

tion  the  ligamentous  contraction  is  drawing  one  side  of  a 
vertebra  upward,  the  thumb  should  be  placed  upon  the  supe- 
rior surface  of  the  transverse  process  which  is  displaced  supe- 
riorly, and  the  thrust  directed  toward  the  sacrum ;  in  a  rotary 
subluxation  the  greater  force  is  directed  along  the  arm  which 
is  in  contact  with  the  posteriorly  displaced  transverse  process. 

This  hold  is  illustrated  in  Fig.  76. 

The  Crossed  Thumb-Transverse  Hold. — Indications. — 
These  are  the  same  as  those  for  the  hold  described  above. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion, with  the  sections  of  the  table  separated,  and  the  operator 
standing  at  either  side. 

Points  of  contact. — The  thumbs  instead  of  being  applied 
on  the  transverse  processes  of  the  corresponding  sides  are 
crossed. 

Method  of  delivery. — This  is  the  same  as  that  described 
under  the  Thumb-Transverse  hold. 

This  hold  is  illustrated  in  Fig.  77 . 

The  Crossed  Bilateral  Pisiform-Transverse  Hold. — Indica- 
tions.— This  is  the  best  hold  for  correction  of  subluxations  of 
the  upper  eight  thoracic  vertebrae.  It  is  adapted  to  the  cor- 
rection of  posterior,  compression,  supero-inferior,  and  rotary 
subluxations. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion. 

Points  of  contact. — The  pisiform  process  of  the  operator's 
right  hand  is  placed  upon  the  transverse  process  of  the  right 
side  of  the  vertebra  to  be  adjusted ;  the  pisiform  process  of 
the  operator's  left  hand  is  placed  on  the  transverse  process 
of  the  right  side. 

Method  of  delivery.- — The  operator  should  stand  at  the 
side  of  the  patient  and  near  him,  with  the  center  of  his  body 
opposite  the  point  of  contact  with  the  vertebra  to  be  adjusted. 
This  position  will  obviate  the  possibility  of  the  crossed  wrists 
interfering  with  each  other.  Care  must  also  be  exercised  to 
secure  the  proper  poise  before  making  the  thrust  with  this 
hold,  as  otherwise  the  force  of  the  thrust  will  not  be  properly 
delivered.  The  arms  should  be  perpendicular  to  the  back  of 
the  patient,  and  the  elbows  rigid.  The  application  and  direc- 
tion of  the  force  will  depend  upon  the  nature  of  the  subluxa- 


THORACIC  VER'lEBRAE  347 

tion  which  is  being  adjusted.  In  a  posterior  subluxation  the 
force  is  directed  directly  downward  equally  along  each  arm 
to  the  contact  points.  In  a  compression  subluxation  in  which 
a  vertebra  is  approximated  toward  the  one  below  it,  the  con- 
tact is  with  the  inferior  surface  of  the  transverse  processes 
and  the  force  of  the  thrust  is  directed  toward  the  head ;  if 
the  ligamentous  contraction  draws  a  vertebra  upward  against 
the  vertebra  above,  the  contact  is  with  the  superior  surface 
of  the  transverse  processes,  and  the  force  of  the  thrust  is 
directed  toward  the  sacrum.  In  cases  of  supero-inferior  sub- 
luxations the  same  rules  apply  as  for  compression  subluxations 
except  that  the  thrust  is  directed  against  only  one  transverse 
process.  In  a  rotary  subluxation  the  force  is  directed 
downward  upon  the  transverse  process  which  is  posteriorly 
displaced. 

This  hold  is  illustrated  in  Fig.  78. 

The  Bilateral  Pisiform-Transverse  Hold. — Indications. — 
This  is  a  very  useful  hold,  and  is  best  adapted  to  correction 
of  subluxations  from  the  seventh  to  the  twelfth  thoracic,  and 
in  all  the  lumbar  vertebrae.  In  some  cases  it  may  be  used 
in  the  entire  thoracic  region ;  this  will,  however,  depend  upon 
the  conformity  of  the  patient's  back  and  the  operator's  ability 
to  acquire  the  hold.  A  milder  movement  may  be  made"  with 
this  hold  than  with  the  same  hold  with  the  hands  crossed. 
When  a  very  mild  adjustment  is  desired,  there  is  no  better 
hold  than  this,  as  spontaneity  can  be  obtained  without  the 
peculiar  shock  characteristic  of  some  of  the  other  holds  where 
rigidity  of  the  arms  is  an  essential  factor  to  a  successful  de- 
livery. This  hold  is  used  in  correcting  posterior,  kyphotic, 
compression,  and  rotary  subluxations. 

Position  of  the  patient. — The  patient  should  be  in  the 
prone  position,  with  the  sections  of  the  table  separated  and 
the  front  section  lowered. 

Points  of  contact. — By  the  term  pisiform-transverse  hold 
it  is  not  meant  to  be  understood  that  the  pisiform  processes 
are  placed  directly  on  the  transverse  processes;  on  the  con- 
trary, they  are  placed  immediately  in  front,  behind,  or  to  the 
side,  as  is  made  necessary  by  the  nature  of  the  subluxation. 
The  right  hand  is  placed  on  the  transverse  process  of  the 
right   side,   while   the   left   hand   is   in   contact   with    the   left 


348 


SPINAL  ADJUSTMENT 


Fig.  80. 
Unilateral    Pisiform-Tiansverse    Hold. 


THORACIC  VERTEBRAE 


349 


Fig.  81. 

T'liui  SpiiiDiis    Ho](l. 


350 


SPINAL  ADJUSTMENT 


Fig.  82. 

Calcaneo-Pislform-Trans verso  Hold. 


THORACIC  VERTEBRAE 


351 


Fig.  83. 

Uilateial  Digito-Transverse  Hold. 


352  SPINAL  ADJUSTMENT 

transverse  process.  When  a  vertebra  is  displaced  posteriorly 
the  contact  is  directly  on  the  transverse  processes.  When  the 
subluxation  is  rotary,  the  contact  is  similar,  but  the  greater 
force  is  directed  toward  the  transverse  process  which  is  pos- 
teriorly displaced.  In  an  upward  approximation  of  a  vertebra, 
the  contact  is  with  the  superior  surface  of  the  transverse 
processes ;  when  it  is  inferiorly  approximated  the  contact  is 
with  the  inferior  surface  of  the  transverse  processes. 

Method  of  delivery. — The  proper  contact,  as  above  indi- 
cated, having  been  secured,  a  spontaneous  movement  from 
the  forearms,  and  an  upward  turn  of  the  wrist  should  be 
made.  The  direction  of  the  force  is  determined  by  the  nature 
of  the  subluxation.  In  a  posterior  or  kyphotic  subluxation, 
it  is  directed  downward.  When  a  rotary  subluxation  is  pres- 
ent the  force  is  directed  principally  along  one  arm,  namely 
that  in  contact  with  the  posteriorly  displaced  transverse 
process.  In  a  compression  subluxation,  when  the  vertebra 
is  drawn  upward  the  thrust  is  directed  toward  the  sacrum ; 
when  it  is  inferiorly  displaced  the  force  is  directed  toward 
the  head. 

This  hold  is  illustrated  in  Fig.  91  in  the  chapter  on  the 
adjustment  of  the  lumbar  vertebrae. 

The  Pisiform-Spinous  Hold.^ — Indications. — This  hold  is 
used  principally  for  the  correction  of  kyphotic  subluxations, 
and  in  some  forms  of  lumbar  subluxations  in  certain  cases. 
This  hold  may,  however,  be  used  for  the  correction  of  any 
form  of  subluxation,  but  will  prove  to  be  more  severe  and 
disagreeable  to  the  patient  than  other  holds  here  suggested, 
and  its  use  should  therefore  be  limited  to  the  indications  above 
mentioned. 

Position  of  the  patient. — The  patient  should  be  in  the 
prone  position ;  the  operator  stands  to  either  side  as  necessary. 

Points  of  contact. — The  pisiform  process  of  one  hand  is 
placed  upon  the  spinous  process  of  the  vertebra  to  be  adjusted  ; 
the  other  hand  grasps  the  wrist  of  the  contact  hand. 

Method  of  delivery. — In  giving  the  thrust  the  arm  which 
grasps  the  wrist  of  the  contact  hand  should  be  held  rigid ; 
a  peculiar  swing  of  the  shoulders  is  then  made  and  the  force 
directed  in  the  proper  direction. 

This  hold  is  illustrated  in  Fif?.  79. 


THORACIC  VERTEBRAE  353 

The  Unilateral  Pisiform-Transverse  Hold.— Indications. 
— Rotary,  lateral,  and  supero-inferior  subluxations  in  the 
dorsal  region  of  the  spine. 

Position  of  the  patient. — The  patient  should  be  in  the 
prone  position.  The  two  sections  of  the  table  should  be 
separated,  and  the  front  section  depressed. 

Points  of  contact. — The  pisiform  process  directly  upon 
the  transverse  process  which  is  posterior  in  rotary  subluxa- 
tions. In  supero-inferior  subluxations  in  which  the  contrac- 
tion of  the  ligaments  is  on  the  side  which  is  drawn  upward 
the  contact  should  be  on  that  side  and  upon  the  superior 
surface  of  the  transverse  process;  when  the  contraction  of 
the  ligaments  is  such  as  to  draw  the  vertebra  downward  on 
one  side  the  contact  should  be  with  the  inferior  surface  of 
the  transverse  process  which  is  inferiorly  displaced.  In  lateral 
or  scoliotic  subluxations  the  contact  is  on  the  transverse 
process,  but  the  force  is  directed  against  the  side  of  the 
spinous  process.  The  other  hand  grasps  the  wrist  of  the 
contact  hand. 

Method  of  delivery. — The  contact  having  been  obtained, 
the  force  of  the  thrust  is  directed  principally  through  the  con- 
tact hand,  and  in  that  direction  necessary  to  the  proper  re- 
placement of  the  subluxated  vertebra.  The  points  of  contact 
will  indicate  the  direction  in  which  the  force  should  be 
delivered. 

This  hold  is  illustrated  in  Fig.  80. 

The  Ulno-Spinous  Hold. — Indications. — The  indications, 
position  of  the  patient,  and  method  of  delivery  when  this  hold 
is  used  are  the  same  as  those  of  the  pisiform-spinous  hold. 
The  only  difference  is  in  the  mode  of  contact,  which  in  this 
hold  is  made  with  the  ulnar  border  of  the  hand  upon  the 
spinous  process;  this  becomes  necessary  in  individuals  who 
are  very  sensitive. 

This  hold  is  illustrated  in  Fig.  81. 

The  Calcaneo-Pisiform-Transverse  Hold. — Indications. — 
This  hold  is  employed  for  the  correction  of  rotary  and  lateral 
displacements. 

Position  of  the  patient. — The  patient  is  in  the  prone 
position. 


354 


SPINAL  ADJUSTMENT 


THORACIC  VERTEBRAE 


35: 


Fig.  85. 
Maiidilmlo  Spinnns   Hold. 


356 


SPINAL  ADJUSTMENT 


Fig.  86. 
Calcaneo-Spinous  Hold. 


THORACIC  VERTEBRAE 


357 


Fig.  87. 
Sacro-Spinous  Hold. 


358  SPINAL  ADJUSTMENT 

Points  of  contact. — One  hand  is  placed  perpendicularly  to 
the  long  axis  of  the  spine,  with  the  pisiform  process  on  the 
transverse  process  which  is  posteriorly  displaced  in  a  rotary 
subluxation ;  or  in  a  lateral  subluxation,  on  the  side  toward 
which  the  vertebra  is  displaced.  The  other  hand  is  placed 
horizontally  to  the  long  axis  of  the  spine,  and  the  crease  be- 
tween the  pisiform  process  and  the  base  of  the  thumb  is  in 
contact  with  the  transverse  process  of  the  other  side. 

Method  of  delivery. — The  manner  of  delivery  of  the  thrust 
is  the  same  as  that  described  in  the  preceding  holds.  The 
principal  force  is,  however,  directed  to  the  hand  in  contact 
with  the  spine  which  is  placed  perpendicularly  to  the  long 
axis  of  the  spine.  A  small  portion  of  the  force  is  directed  to 
the  other  hand,  which  is  applied  principally  as  a  guard  against 
slipping  of  the  tissues,  and  as  a  gauge  in  the  delivery  of  the 
thrust.  In  a  rotary  subluxation  the  force  is  directed  directly 
downward ;  in  a  lateral  subluxation  it  is  directed  toward  the 
side  from  which  the  vertebra  is  displaced. 

This  hold  is  illustrated  in  Fig.  82. 

The  Bilateral  Digito-Transverse  Hold. — Indications. — Pos- 
terior and  rotary  subluxations  from  the  fourth  to  the  ninth 
thoracic  vertebrae. 

Position  of  the  patient. — The  patient  should  be  in  the 
prone  position. 

Points  of  contact. — The  index  and  middle  finger  of  the 
contact  hand  are  placed  upon  the  transverse  process  of  one 
side  of  the  vertebra  to  be  adjusted;  the  ring  and  little  finger 
are  placed  upon  the  transverse  process  of  the  other  side.  The 
other  hand  is  placed  on  the  dorsal  surface  of  the  contact 
hand  to  assist  in  giving  the  proper  force  to- the  thrust. 

Method  of  delivery. — In  a  posterior  subluxation  the  force 
is  directed  upon  both  transverse  processes  equally,  with  the 
characteristic  spontaneous  thrust.  In  a  rotary  subluxation 
the  greater  force  is  directed  toward  one  side,  namely  upon 
the  transverse  process  which  is  posteriorly  displaced. 

This  hold  is  illustrated  in  Fig.  83. 

The  T.  M.  Hold. — Indications. — This  hold  is  useful  in 
adjustment  of  the  upper  three  or  four  dorsal  vertebrae,  in 
addition  to  the  lower  cervical.  It  is  adapted  to  correction 
of  lateral  and  rotary  subluxations. 


THORACIC  Vl'lkl  J'P.KAl'-.  339 

Position  of  the  patient. — The  patient  is  in  the  ereet  posi- 
tion and  seated.  The  operator  stands  behind  the  patient,  or 
slightly  to  one  side. 

Points  of  eontact. — The  thnndj  of  one  hand  is  plaeed 
against  the  side  of  the  spinous  process  while  the  hand  as  a 
whole  is  supported  by  resting  the  fingers  upon  the  patient's 
shoulder;  the  thumb  is  placed  on  that  side  of  the  spinous 
process  toward  which  the  vertebra  is  displaced.  The  other 
hand  is  placed  against  the  side  of  the  patient's  face  and  head, 
and  the  elbow  may  rest  on  the  patient's  shoulder  on  that  side. 

Method  of  delivery.— The  patient's  head  is  flexed  toward 
the  contact  point  to  the  farthest  extent,  and  a  simultaneous 
thrust  made  with  both  hands  toward  each  other.  Care  must, 
be  exercised  to  prevent  slipping  of  the  thumb  at  the  moment 
the  thrust  is  made  against  the  side  of  the  spinous  process. 

This  hold  is  illustrated  in  Fig.  84. 

The  Mandibulo-Spinous  Hold. — Indications. — Rotary  sub- 
luxations in  the  upper  thoracic  region. 

Position  of  the  patient. — The  patient  is  in  the  erect  position 
and  seated. 

Points  of  contact. — The  contact  of  the  hand  with  the  ver- 
tebra to  be  adjusted  is  the  same  in  this  hold  as  it  is  in  the 
T.  M.  hold,  namely,  with  the  thumb  placed  against  the  side 
of  the  spinous  process  toward  which  thcj  vertebra  is  rotated, 
with  the  fingers  placed  on  the  shoulder  of  the  patient.  The 
other  hand  grasps  the  patient's  chin. 

Method  of  delivery. — The  patient's  face  is  turned  away 
from  the  side  on  which  the  contact  hand  is  placed.  When 
the  limit  of  rotation  of  the  head  has  been  reached,  a  thrust 
is  given  with  both  hands  at  the  same  time,  the  direction  of 
the  force  being  applied  toward  each  other. 

This   hold   is   illustrated   in    Fig.   85. 

The  Calcaneo-Spinous  Hold. — Indications. — This  hold  is 
adapted  to  correction  of  posterior  and  compression  subluxa- 
tions in  the  thoracic  and  lumbar  regions. 

Position  of  the  patient.^ — The  patient  should  be  in  the 
prone  position. 

Points  of  contact. — In  a  posterior  subluxation  the  groove 
between  the  pisiform  bone  and  the  base  of  the  thumb  is 
placed  directly  upon  the  tip  of  the  spinous  process.     In  an 


360 


SPINAL  ADJUSTMENT 


Fig.  88. 
Thoracic  Extension  Hold  I. 


THORACIC  VJiRIEBRAE 


361 


Fig.  89. 
Thoracic  Extension  Hold  II. 


362 


SPINAL  ADJUSTMENT 


Fig.  90. 
The    "Recoil"    (Palmer). 


THORACIC  VERTEBRAE  363 

approximation  or  compression  subluxation  the  contact  of  the 
heel  of  the  hand  is  with  the  superior  surface  of  tiie  spinous 
process  when  the  vertebra  is  superiorly  approximated,  and 
with  the  inferior  surface  of  the  tip  of  the  spinous  process 
when  the  vertebra  is  inferiorly  approximated.  The  wrist  of 
the  contact  hand  is  grasped  by  the  other  hand. 

Method  of  delivery. — The  fingers  of  the  contact  hand  ex- 
tend along  the  patient's  spine,  and  the  arm  of  the  contact 
hand  is  perfectly  straight  and  rigid.  In  a  posterior  subluxa- 
tion the  force  of  the  thrust  is  directed  directly  downward, 
perpendicularly  to  the  patient's  back.  When  the  vertebra  is 
approximated  superiorly,  the  force  of  the  thrust  is  directed 
toward  the  sacrum ;  when  the  vertebra  is  approximated  with 
the  one  below  it,  the  force  of  the  thrust  is  directed  toward 
the  head  of  the  patient. 

This  hold  is  illustrated  in  Fig.  86. 

The  Sacro-Spinous  Hold. — Indications. — This  is  not  a  spe- 
cific method  of  adjustment,  but  may  be  used  for  the  purpose 
of  causing  extension  of  the  vertebral  column,  and  may  be 
used  to  advantage  especially  in  lordotic  displacement  of  a 
section  of  the  spine. 

Position'  of  the  patient. — The  patient  should  be  in  the 
prone  position,  with  front  section  of  the  table  depressed. 

Points  of  contact. — One  hand  is  placed  on  the  sacrum, 
while  the  other  is  in  contact  with  the  spinous  processes. 

Method  of  delivery. — No  specific  thrust  is  given.  The 
hands  press  upon  the  sacrum  and  spinous  process  simultane- 
ously, very  forcibly  and  steadily,  in  this  way  obtaining  a 
considerable  extension  of  the  spine. 

This  hold  is  illustrated  in  Fig.  87. 

The  Thoracic  Extension  Hold  I. — Indications. — This  also 
is  not  a  specific  method  of  adjustment,  and  is  used  for  opening 
the  thoracic  articulations  and  relieving  contractured  condi- 
tions of  the  vertebral  ligaments.  In  what  is  commonly  known 
as  "backache"  and  which  is  simply  a  settling  of  the  vertebrae 
upon  each  other  application  of  this  hold  gives  great  relief. 

Position  of  the  patient. — The  patient  should  stand  erect 
and  reclining  slightly  backward,  with  the  hands  folded  and 
placed  behind  the  head,  which  is  thrown  a  little  forward.  The 
operator  stands  behind  the  patient  facing  the  latter's  back. 


364  SPINAL  ADJUSTMENT 

Points  of  contact. — The  operator  passes  his  hands  under 
the  patient'  arms  and  grasps  the  wrists. 

Method  of  delivery. — The  patient  is  lifted  suddenly  from 
the  floor  and  at  the  same  time  a  quick  upward  jerk  is  given  the 
body. 

This  hold  is  illustrated  in  Fig.  88. 

The  Thoracic  Extension  Hold  II. — Indications. — ^The  indi- 
cations for  this  movement  are  the  same  as  those  for  the 
preceding.    In  some  instances  it  is  preferable. 

Position  of  the  patient. — The  patient  is  erect,  with  the 
elbows  flexed  and  brought  together,  while  the  hands  are 
placed  on  either  side  of  the  face. 

Points  of  contact. — The  operator  stands  directly  behind 
the  patient,  with  the  latter's  elbows  in  the  hollow  of  his 
hands. 

Method  of  delivery. — The  patient  is  suddenly  lifted  from 
the  floor,  and  at  the  same  instant  a  quick  upward  jerk  is 
given  the  body. 

This  hold  is  illustrated  in  Fig.  89. 

The  "Recoil." — This  hold  is  the  exclusive  method  of  ad- 
justment used  by  some  operators  in  all  regions  of  the  spine 
and  for  all  forms  of  subluxation,  the  contact  being  upon  the 
spinous  processes  in  every  instance.  The  force  of  the  thrust 
is  directed  in  the  direction  in  which  the  vertebra  is  to  be 
replaced.  The  advantages  claimed  for  this  hold  by  its  advo- 
cates and  the  disadvantages  ascribed  to  it  by  its  opponents 
practically  outweigh  each  other  in  the  opinion  of  the  author. 
We  make  use  of  the  spinous  processes  in  many  instances  but 
feel  that  there  are  cases  in  which  the  use  of  the  transverse 
processes  of  the  subluxated  vertebra  as  the  levers  is  much  to 
be  preferred. 

This  hold  is  illustrated  in  Fig.  90. 


CHAPTER  IV 

Adjustment  of  the  Lumbar  Vertebrae 

The  Bilateral  Pisiform-Transverse  Hold. — This  hold  will 
be  found  described  fully  in  chapter  three  of  this  section,  and 
is  illustrated  in  Fig,  91. 

The  Ulno-Spinous  Hold. — This  hold  is  also  described  in 
the  chapter  dealing  with  the  adjustment  of  the  dorsal 
vertebrae. 

Figure  92  illustrates  this  hold,  which  shows  the  force  of 
the  thrust  directed  downward  toward  the  sacrum,  while  in 
the  previous  chapter  the  illustration  of  this  hold  shows  the 
thrust  being  delivered  toward  the  patient's  head. 

The  Ilio-Spinous  Hold.— Indications. — This  is  more  in  the 
nature  of  a  gymnastic  or  passive  movement  than  a  specific 
thrust.  It  is,  however,  very  useful  in  correcting  scoliosis  in 
both  the  lumbar  and  thoracic  regions. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion; the  table  is  closed,  and  both  sections  are  at  the  same 
level. 

Points  of  contact. — One  hand  of  the  operator  grasps  the 
anterior  superior  spine  of  the  ilium,  while  the  heel  of  the  other 
hand  is  pressed  firmly  against  the  spinous  processes  on  the 
side  toward  which  the  curve  is  directed. 

Method  of  delivery. — The  hand  in  contact  with  the  spinous 
processes  pushes  them  over  to  the  opposite  side  to  that  in 
which  the  curve  is  directed,  while  at  the  same  time  the  other 
hand  draws  up  the  patient's  hip.  This  movement  is  repeated 
a  number  of  times  as  made  necessary  by  the  degree  of  the 
scoliosis. 

This  hold  is  illustrated  in  Fig.  93. 

The  Thumb-Transverse  Hold. — Indications. — This  hold  is 
adapted  to  correction  of  posterior,  kyphotic,  and  rotary  sub- 
luxations in  the  lumbar  region. 

For  other  points  concerning  this  hold  the  reader  is  re- 

365 


366 


SPINAL  ADJUSTMENT 


Fig.  91. 
HilatiM'al   Pisifonn-Transvorpp   Hold. 


LUMBAR  VERTEBRAE 


367 


Fig.  92. 
Ulno  SpiiKins   Hold. 


368 


SPINAL  ADJUSTMENT 


Fig.  93. 

Ilio-Spinous  Hold. 


LUMBAR  VERTEBRAE 


369 


Fig.  94. 
Supra  Sacral  Held. 


370  SPINAL  ADJUSTMENT 

ferred  to  the  preceding  chapter  in  which  the  methods  of  de- 
livery and  points  of  contact  are  fully  described. 

The  Pisiform-Spinous  Hold. — Indications. — This  hold 
which  is  fully  described  in  the  preceding  chapter  is  indicated 
in  posterior,  compression,  and  rotary  subluxations  of  the 
lumbar  region. 

The  Unilateral  Pisiform-Transverse  Hold. — This  hold  is 
described  and  illustrated  in  the  preceding  chapter.  In  the 
lumbar  region  it  is  indicated  in  rotary  and  supero-inferior 
subluxations. 

The  Supra-Sacral  Hold. — Indications.-^This  hold  is  used 
for  the  purpose  of  freeing  the  articulation  between  the  fifth 
lumbar  vertebra  and  the  sacrum. 

Position  of  the  patient. — The  patient  is  in  the  prone  posi- 
tion. The  front  section  of  the  table  is  lowered,  thus  elevating 
the  sacral  region. 

Points  of  contact. — The  right  hand  of  the  operator  is  placed 
upon  the  sacrum,  and  the  wrist  of  the  contact  hand  is  grasped 
by  the  other  hand. 

Method  of  delivery.— -The  contact  having  been  secured,  a 
quick,  spontaneous,  downward  thrust  is  made. 

This  hold  is  illustrated  in  Fig.  94. 

The  Supra-Iliac  Hold. — Indications. — This  hold  is  useful 
in  correcting  approximation  of  the  fifth  lumbar  vertebra  and 
the  sacrum.  This  condition  will  be  noted  by  the  difference 
which  exists  in  the  height  of  the  crests  of  the  ilia  when  the 
compression  exists  on  one  side  of  the  disc  between  the  fifth 
lumbar  verte1:)ra  and  the  sacrum,  namely  a  supero-inferior 
subluxation. 

Position  of  the  patient. — The  patient  should  be  in  the  prone 
position.  The  front  section  of  the  table  is  lowered,  thus 
throwing  the  pelvis  of  the  patient  upward. 

Points  of  contact. — One  hand  is  placed  upon  the  crest  of 
the  ilium,  and  the  wrist  of  the  contact  hand  grasped  with  the 
other  hand. 

Method  of  delivery. — The  contact  with  the  higher  ilium 
having  been  obtained,  a  sudden  thrust  downward  is  delivered. 

This  hold  is  illustrated  in  Fig.  95. 

The  Infra-Iliac  Hold. — Indications. — These  are  the  same 
as  those  for  the  preceding  hold. 


LUMBAR  VERTEBRAE  371 

Position  of  the  patient. — The  patient  is  in  the  prone 
position  with  the  pelvis  elevated. 

Points  of  contact. — One  hand  is  placed  below  the  crest 
of  the  ilium,  and  the  wrist  of  the  contact  hand  grasped  by  the 
other  hand. 

Method  of  delivery. — The  thrust  in  this  case  is  directed 
upward. 

This  hold  is  illustrated  in  Fig.  96. 

The  Genu-Spinous  Hold. — Indications. — This  hold  is 
adapted  to  a  correction  of  compression  subluxations  in  the 
lumbar  region,  and  is  a  counterpart  of  the  Fronto-Transversc 
and  Parieto-Transverse  holds  used  in  the  cervical  region.  It 
is  also  used  for  correcting  posterior,  scoliotic,  supero-inferior, 
and  rotary  subluxations  in  the  lumbar  region,  which  it 
accomplishes  by  causing  a  relaxation  of  the  ligaments. 

Position  of  the  patient. — The  patient  should  be  in  the  prone 
position,  with  the  front  section  of  the  table  slightly  lowered. 

Points  of  contact. — The  heel  of  the  contact  hand  is  placed 
against  the  spinous  processes  of  the  vertebrae  to  be  adjusted, 
wdiile  the  other  hand  grasps  the  knee. 

Method  of  delivery. — The  leg  is  raised  and  drawn  toward 
the  operator,  until  the  spine  is  markedly  flexed.  At  the  same 
time  firm  pressure  is  made  against  the  spinous  processes  by 
the  hand  in  contact  therewith.  A  sudden  thrust  is  then  given 
with  the  contact  hand  and  at  the  same  time  the  leg  is  drawn 
upward.  The  direction  of  the  thrust  will  depend  upon  the 
nature  of  the  subluxation.  In  a  posterior  subluxation  the 
force  is  directed  downward.  In  a  rotary  subluxation  the  con- 
tact is  with  the  side  of  the  spinous  process  toward  which  the 
vertebra  is  rotated,  and  the  force  of  the  thrust  is  applied  in 
the  opposite  direction.  In  a  compression  subluxation  the 
force  is  directed  downward,  as  well  as  in  a  supero-inferior 
subluxation,  since  this  will  relieve  ligamentous  contraction, 
and  permit  the  vertebra  to  return  into  alignment. 

This  hold  is  illustrated  in  Fig.  97. 

The  Ilio-Deltoid  Hold. — Indications. — This  hold  is  very 
useful  in  loosening  up  the  lumbar  and  lower  thoracic  articula- 
tions. This  is  not  a  specific  method  for  adjusting  the  verte- 
brae 1)ut  it  is  fdllowed  by  very  good  results  in  settling  of  this 
part  of  the  s])ine  and  in  lumbago. 


372 


SPINAL  ADJUSTMENT 


Fig.  95. 
Supra-Iliac  Hold. 


LUMBAR  VERTEBRAE 


Z7Z 


Fig.  96. 
lufra-Iliac  Hold. 


374 


SPINAL  ADJUSTMENT 


LUMBAR  VKKri:i'.K.\E 


375 


Fig.  98. 
Ilio-Deltoid  Hold. 


Z76 


SPINAL  ADJUSTMENT 


Fia.  99. 
Geuu-Deltoid  Hold. 


LUMBAR  VERTEBRAE  Z77 

Position  of  the  patient. — The  patient  should  he  on  the 
side,  with  the  arm  which  is  next  the  table  placed  under  the 
head. 

Points  of  contact. — The  operator  should  stand  at  one  side 
of  the  patient  and  facing  the  subject.  One  hand  is  placed 
upon  the  posterior  portion  of  the  ilium,  while  the  other  hand 
grasps  the  anterior  portion  of  the  shoulder. 

Method  of  delivery. — -The  contact  having  been  obtained, 
the  shoulder  of  the  patient  is  pushed  backward  while 
the  hip  is  drawn  forward  to  the  limit  of  normal  motion. 
A  simultaneous  thrust  of  both  hands  is  then  made. 

This  hold  is  illustrated  in  Fig.  98. 

The  Genu-Deltoid  Hold. — Indications. — These  are  the 
same  as  those  for  the  preceding  hold. 

Position  of  the  patient. — The  patient's  position  is  the  same 
as  above. 

Points  of  contact. — One  hand  grasps  the  anterior  portion 
of  the  shoulder,  while  the  other  holds  the  .under  surface  of 
the  knee. 

Method  of  delivery. — The  patient  is  drawn  toward  the  edge 
of  the  table.  The  leg  next  the  table  should  be  extended.  The 
other  is  brought  down  over  the  edge  of  the  table,  the  operator 
grasping  the  under  aspect  of  the  knee.  The  thigh  is  then 
sharply  flexed  upon  the  abdomen,  and  the  knee  also  is  flexed, 
and  brought  to  a  point  midway  between  the  operator's  knees, 
the  foot  resting  upon  his  thigh.  Downward  pressure  is  next 
made  with  the  hand  upon  the  knee;  at  the  same  time  the 
shoulder  is  pushed  backward  by  the  hand  in  contact  therewith, 
thus  producing  by  these  movements  a  decided  rotation  of  the 
lower  part  of  the  spine.  When  the  tension  thus  produced  has 
reached  the  normal  limit  a  quick  thrust  is  given  with  either 
hand,  namely  the  hips  are  brought  forcibly  forward  and  at 
the  same  time  the  shoulder  is  forced  backward.  The  other 
side  of  the  spine  may  be  similarly  afifected  by  simply  reversing 
the  hold. 

This  hold  is  illustrated  in  Fig.  99. 


CHAPTER  V 


Regional  Classification  of  Holds 

In  the  following  table  the  various  subluxations  in  the 
different  regions  of  the  spinal  column  are  given,  together  with 
the  holds  applicable  in  each : 


Megion  of  Spine  Subluxations 

Cervical  Eotary 


Lateral 


Dorsal 


Supero-Inferior 
Compression 


Scoliotic 
Anterior 

Posterior 


Kyphotic 


Lordotic 


Scoliotic 


Compression 


Holds  to  Be  Used 
Tcni|ioroTransverse    Hold 
T.  M.  Hold 

Unilateral   Pisiform-Transverse   Ante- 
rior Hold 
TemporoTransverse  Hold 
T.  M.  Hold 
Temporo-Centrum  Hold 

Temporo-Transverse    Hold 
Fronto-Transverse  Hold 
Parieto-Transverse  Hold 
Temporo-Occipital  Hold    (for  atlas) 
Occipito-Mandibular  Hold  I 
Occjpito-Mandibular  Hold  II 
Occipito-Mandibular   Hold   III 
Temporo-Transverse  Hold 
Bilateral     Pisiform-Transverse     Ante- 
rior  Hold 
Thumb-Transverse  Hold 
Crossed   Thumb-Transverte   Hold 
Ch-ossed   Pisiform-Transverse   Hold 
Bilateral  Pisiform-Transverse  Hold 
Bilateral  Digito-Transverse  Hold 
Calcaneo-Spinous  Hold 

Thumb-Transverse  Hold 

Crossed  Bilateral  Pisiform-Transverse 

Hold 
Bilateral  Pisiform-Transverse  Hold 
Pisiform-Spinous  Hold 
Ulno-Spinous  Hold 
Sacro-Spinous  Hold 
Traction 

Unilateral  Pisiform- Transverse  Hold 
T.  M.  Hold  (in  upper  dorsals) 
Ilio-Spinous  Hold 
Traction 

Thumb-Transverse  Hold 
Crossed  Thumb-Transverse  Hold 
Crossed  Bilateral  Pisiform-Transverse 

Hold 
Bilateral  Pisiform-Transverse   Hold 
Calcaneo-Spinous  Hold 


378 


CLASSIFICAIIUN  ()!•   ilULUS 


379 


Region  of  Spine         Subluxations 
Sii2)cro-Inferior 


Lateral 


Eotary 


Lumbar 


Posterior 


Kyphotic 


Lordotic 


Scoliotic 


Compression 


Supero-Iuferior 


Anterior   (5L.) 


Eotary 


Uuld.s  to  ]{(    U.scd 
Thuiiil)-Tran.svcr;^i;   Hold 
Crossed   Thurnh-Transvcrso  Hold 
Crossed  Bilateral  Pisiform-Transverse 

Hold 
Bilateral  Pisiform-Transverse  Hold 
Unilateral  Pisiform-Transverse  Hold 

Unilateral  Pisiform-Transverse  Hold 
Calcaneo-Pisiform-Tiansverse    Hold 
T.  M.  Hold 

Thumb-Transverse  Hold 
Crossed  Tliumb-Transvcr^o  Hold 
Crossed  Bilateral  Pisiform-Transvcrs-e 

Hold 
Bilateral  Pisiform-Transverse  Hold 
Unilateral  I'isiform-Transverse  Hold 
Calcaneo-Pisiform-Transversc    Hold 
Bilateral   Digito-Transver^e  Hold 
Mandibulo-Spinous  Hold 
T.  M.  Hold 

Bilateral  Pisiform-Transverse  Hold 
Calcaneo  Spinous  Hold 
Thumb-Transverse   Hold 
Pisiform-Spinous  HoM 
Genu-Spinous  Hold 

Bilateral   Pisiform-Transverf-e   Hold 
Thumb-Transverse  Hold 

Sacro-Spinous  Hold 
Traction 

Ilio-Spinous  Hold 
Genu-Spinous  Hold 

Calcaneo  Spinous  Hold 
Pisiform-Spinous  Hold 
Genu-Spinous  Hold 
Genu-Deltoid  Hold 

Bilateral   Pisiform-Transverse   Hold 
Unilateral   Pisiform-Transverse  Hold 
Genu-Spinous  Hold 
Genu-Deltoid  Hold 

Supra-Sacral  Hold 
Bilateral  Pisiform-Transverse  Hold 
(applied  on  the  4th  lumbar) 

Thumb-Transverse  Hold 
Pisiform-Spinous  Hold 
Unilateral  Pisiform-Transverse  Hold 
Bilateral  Pisiform-Transverse  Hold 
Genu-Spinous  Hold 


In  the  following  table  are  given  the  different  forms  of 
subluxations,  and  the  holds  adapted  to  the  correction  of  each 
depending  upon  the  region  of  the  spine  in  which  thev  are 
situated. 


380  SPINAL  ADJUSTMENT 

Lateral  Subluxation: 
Cervical  Region — 

Temporo-Transverse  Hold. 
T.  M.  Hold  (6-7C). 
Temporo-Centrum   Hold. 
Dorsal  Region — 

Unilateral  Pisiform-Transverse  Hold. 
Calcaneo-Pisiform-Transverse  Hold. 
T.  M.  Hold  (1-2-3D). 

Rotary  Subluxation: 
Cervical  Region — 

Temporo-Transverse  Hold. 

T.  M.  Hold  (6-7C). 

Unilateral  Pisiform-Transverse  Anterior  Hold. 
Dorsal  Region — 

Thumb-iTransverse    Hold. 

Crossed  Thumb-Transverse  Hold. 

Crossed   Bilateral   Pisiform-Transverse   Hold. 

Bilateral  Pisiform-Transverse  Hold. 

Unilateral   Pisiform-Transverse   Hold. 

Calcaneo-Pisiform-Transverse  Hold. 

Bilateral  Digito-Transverse  Hold. 

T.  M.  Hold  (1-2-3D). 

Mandibulo-Spinous  Hold. 
Lumbar  Region — 

Bilateral   Pisiform-Transverse   Hold. 

Unilateral  Pisiform-Transverse  Hold. 

Pisiform-Spinous  Hold. 

Genu-Spinous  Hold. 

Supero-Inferior  Subluxation : 
Cervical  Region — 

Temporo-Transverse  Hold. 
Dorsal  Region — 

Thumb-Transverse  Hold. 
,  Crossed  Thumb-Transverse  Hold. 

Crossed  Bilateral  Pisiform-Transverse  Hold. 

Bilateral  Pisiform-Transverse  Hold. 

Unilateral   Pisiform-Transverse   Hold. 

Genu-Spinous   Hold. 


CLASSIFICATION  OF  HOLDS  381 

Lumbar  Region — 

Bilateral  Pisiform-Transverse  Hold. 
Unilateral  Pisiform-Transverse  Hold. 
Genu-Spinous  Hold. 
Genu-Deltoid  Hold. 

Compression  Subluxation : 
Cervical  Region — 

Fronto-Transverse  Hold, 

Parieto-Transverse  Hold. 

Occipito-Mandibular  Hold. 

Temporo-Occipital   Hold. 
Dorsal  Region — 

Thumb-Transverse  Hold. 

Crossed  Thumb-Transverse  Hold. 

Crossed  Bilateral  Pisiform-Transverse  Hold. 

Bilateral  Pisiform-Transverse  Hold. 

Calcaneo-Spinous  Hold. 
Lumbar  Region — 

Calcaneo-Spinous  Hold. 

Pisiform-Spinous   Hold. 

Genu-Spinous  Hold. 

Genu-Deltoid  Hold. 

Posterior  Subluxation: 
Dorsal  Region — 

Thumb-Transverse    Hold. 

Crossed  Thumb-Transverse  Hold. 

Crossed  Bilateral  Pisiform-Transverse  Hold. 

Bilateral  Pisiform-Transverse  Hold. 

Bilateral  Digito-Transverse  Hold. 

Calcaneo-Spinous  Hold. 
Lumbar  Region — 

Bilateral  Pisiform-Transverse  Hold. 

Calcaneo-Spinous   Hold. 

Pisiform-Spinous   Hold. 

Genu-Spinous  Hold. 

Anterior  Subluxation: 

Cervical  Region — 

Bilateral  Pisiform-Transverse  Anterior  Hold. 


382  SPINAL  ADJUSTMENT 

Dorsal  Region- — • 

Bilateral    Pisiform-Transverse    Hold     (on    vertebra 

above  and  below  the  one  subluxated). 
Crossed  Bilateral  Pisiform-Transverse  Hold  (on  ver- 
tebra above  and  below  the  one  subluxated) . 
Lumbar  Region — 

Supra-sacral  Hold. 

Bilateral   Pisiform-Transverse   Hold    (on   the   fourth 
lumbar  vertebra). 

Kyphotic  Subluxation: 
Dorsal  Region — 

Thumb-Transverse  Hold. 

Crossed  Thumb-Transverse  Hold. 

Crossed   Bilateral  Pisiform-Transverse  Hold. 

Bilateral  Pisiform-Transverse  Hold. 

Pisiform-Spinous  Hold. 
Lumbar  Region — 

Bilateral   Pisiform-Transverse  Hold. 

Thumb-Transverse   Hold. 

Scoliotic  Subluxation: 
Cervical  Region — 

Temporo-Transverse  Hold. 

T.  M.  Hold  (in  lower  two  cervical  vertebrae). 
Dorsal  Region — 

T.  M.  Hold  (in  upper  three  dorsal  vertebrae). 

Ilio-Spinous  Hold. 
Lumbar  Region — 

Ilio-Spinous  Hold. 

Genu-Spinous  Hold. 

Lordotic  Subluxation: 

Cervical  Region — 

Bilateral  Pisiform-Transverse  Anterior  Hold. 
Dorsal  Region — 

Sacro-Spinous  Hold. 

Traction. 
Lumbar  Region — 

Sacro-Spinous  Hold. 

Traction. 


SECTION  SEVEN 
Practice  of  Spinal  Adjustment 


CHAPTER  I 

Vertebral  Subluxations  and  Disease 

Before  taking  up  the  practical  application  of  spinal  adjust- 
ment, we  wish  to  present  for  the  reader's  consideration  the 
relationship  between  disease  and  vertebral  subluxations. 

The  etiological  factors  in  the  production  of  disease  have 
been  considered  at  length  in  a  number  of  the  preceding  chap- 
ters. We  have  seen  that  the  functional  activity  and  organic 
integrity  of  all  parts  of  the  body,  and  their  harmonious  rela- 
tionship, depend  upon  proper  innervation.  The  withdrawal  of 
this  nervous  influence,  either  entirely  or  in  part,  renders  the 
affected  parts  of  the  body  susceptible  to  disease.  Often  this 
lack  of  innervation  is  sufficient  of  itself  to  result  in  the  devel- 
opment of  disease ;  in  other  cases  the  superimposition  of  con- 
tributing factors  is  necessary.  For  example,  a  subluxation 
in  the  middle  cervical  or  upper  dorsal  region  will  not  cause 
tuberculosis;  but  the  invasion  of  the  respiratory  tract  by 
tubercle  bacilli,  in  the  face  of  a  lowered  vitality,  is  necessary 
to  produce  this  disease.  A  lowered  vitality  is  thus  the  pri- 
mary factor  in  permitting  the  development  of  pulmonary 
tuberculosis,  but  the  resistance  of  the  patient  could  be  abso- 
lutely nil.  and  yet  he  would  not  develop  tuberculosis  in  the 
absence  of  the  bacilli.  On  the  other  hand  the  lack  of  resist- 
ance need  not  depend  upon  a  lowering  of  the  general  vitality, 
but  may  be  confined  to  the  atrium  of  infection  solely.  Tuber- 
cle bacilli  gain  access  to  the  lungs  through  the  upper  part 
of  the  respiratory  tract ;  if  this  portion  of  the  body  is  not 
normal,  it  permits  of  the  multiplication  of  the  bacilli  and  the 
elaboration  of  their  toxins  in  the  area  of  special  predilection 
of  that  particular  bacterium.  The  normal  condition  of  any 
part  of  the  body  is  dependent  uixui  ])r()per  innervation,  and 

383 


384  SPINAL  ADJUSTMENT 

since  the  flow  of  nerve-impulses  is  most  readily  interfered 
with  at  the  intervertebral  foramina,  vertebral  subluxations 
must  be  considered  as  that  factor  which  makes  the  develop- 
ment of  disease  possible.  In  other  words,  subluxations  are  the 
predisposing  causes  of  disease  in  many  instances.  By  this  it 
is  not  meant  that  no  disease  can  occur  unless  a  vertebral  sub- 
luxation is  previously  induced,  since  other  factors  may  act 
as  predisposing  causes  of  diseases.  Thus,  in  the  example 
under  consideration,  heredity  may  be  a  predisposing  cause, 
the  patient  having  inherited  from  a  tubercular  parent  a  tend- 
ency to  contract  this  disease.  Again,  occupations  necessi- 
tating the  assuming  of  cramped  positions  may,  by  preventing 
free  aeration  of  the  lungs,  act  as  predisposing  factors  in  the 
production  of  the  disease.  Residence  in  unhygienic  surround- 
ings, alcoholism,  syphilis,  and  Bright's  disease,  may  similarly 
predispose  the  patient  toward  the  contracting  of  tuberculosis 
when  he  is  exposed  to  the  exciting  cause.  It  must,  however, 
be  remembered  that  even  though  the  general  .health  may  be 
very  much  depraved,  by  any  of  the  above-mentioned  diseases, 
tuberculosis  may  not  develop.  We  do  not  see  tuberculosis  in 
every  patient  suffering  from  chronic  alcoholism,  syphilis,  or 
Bright's  disease,  even  though  the  general  health  is  extremely 
low.  There  must  be  a  further  reason  why  tuberculosis  will 
develop  in  one  such  patient  and  not  in  another,  both  of  whom 
are  equally  exposed  to  the  bacilli,  and  in  the  same  receptive 
condition. 

The  cause  for  this  apparent  anomaly  must  be  sought  for 
in  the  respiratory  tract  itself.  When  this  is  done,  it  will 
nearly  always  be  found  that  the  atrium  of  infection,  namely 
the  respiratory  tract  in  the  patient  who  has  not  developed 
tuberculosis  is  in  a  condition  that  does  not  permit  of  the 
growth  of  the  bacilli.  In  the  other  patient  a  depraved  condi- 
tion of  the  respiratory  tract  is  present,  and  dependent  upon 
readily  demonstrable  spinal  lesions  in  the  middle  cervical 
and  upper  dorsal  region.  This  example  is  equally  applicable 
m  a  majority  of  diseases  and  shows  that  the  primary,  predis- 
posing and  indirect  cause  of  disease  is  subluxations  in  the 
spinal  segment  from  which  the  affected  part  derives  its  inner- 
vation. The  exciting,  direct  or  contributing  causes  are  those 
which   affect   a   particular   part   of   the   body,   and   by   their 


VERTEBRAL  SUBLUXATIONS  385 

character  determine   the   nature   of   the   disease   process  that 
follows. 

It  may  be  asked,  why,  in  view  of  the  fact  tiiat  a  certain 
segment  controls  so  many  different  organs  and  parts  of  the 
body,  are  they  not  all  affected  when  a  subluxation  is  present 
in  that  segment?     This  is  explained  very  readily.     If  a  cer- 
tain segment  is  the  seat  of  a  subluxation  it  is  true  that  all 
the   structures   supplied  by  that  segment  suffer  from   faulty 
innervation ;  that  is  to   say,  their  inherent  resistance   is   im- 
paired.    They  thus  are  constantly  in  a  receptive  condition  to 
the  invasion  of  the  secondary  or  contributing  causes  of  disease. 
Were  their  innervation,  and  consequently  their  organic  integ- 
rity perfect,  they  would  not  so  easily  be  aft'ected  by  extraneous 
influences.     For  example,  if  the  fourth  cervical  vertebra  is 
subluxated  and  pressure  upon  the  corresponding  nerves  suf^- 
cient  to  obstruct  the  conduction  of  impulses  along  them  is 
present,  the  structures  of  the  head  and  face  will  not  receive 
their   proper   amount   of   nerve    supply.      No   actual   disease 
process  may  occur  in  these  parts  so  long  as  no  other  influences 
are  superimposed.     If,  however,  such  an  individual  uses  the 
voice  excessively,  he  will  more  readily  suft'er  from  laryngitis; 
if  an   infection   enters  the  tonsils,  they  will   succumb   to  its 
invasion  more  surely;  if  the  eyes  are  subjected  to  any  delete- 
rious influences,  they  become  more  easily  affected.    Thus  the 
contributing  causes  are  really  secondary,  and  determine  what 
part  will  become   affected.     For  that  reason  we  may  have 
laryngitis,  or  tonsilitis,  or  conjunctivitis,  and  all  may  be  re- 
lieved by  adjustment  of  the  fourth  cervical  vertebra,  since  a 
subluxation  of  that  vertebra  is  the  primary  and  predisposing 
cause  of  all  these  affections.    The  exact  nature  of  the  disease 
and  the  part  involved  depend,  therefore,  upon  the  character 
of  the  contributing  causes  and  the  structure  which  they  af- 
fect.    It  is  for  this  reason  that  the  contributory  etiology  of 
diseases  must  not  be  overlooked,  but  must  be  given  careful 
consideration.     It  frequently  is  of  great  assistance  in  making 
a  diagnosis  of  the  exact  nature  of  an  affection  in  a  certain 
organ.     For  example,  symptoms  may  be  present,  pointing  to 
heart  disease,   and  the   spinal   findings  may  also   show   this 
to  be  the  case.     Yet  the  symptoms  may  not  be  sufficiently 
characteristic  to  make  an  exact  diagnosis  possible.     It  is  here 


386  SPINAL  ADJUSTMENT 

that  reference  to  the  possible  cause  may  solve  the  problem ; 
thus  rheumatism,  scarlet.fever,  or  typhoid  fever  may  be  found 
to  be  contributing  causes,  in  which  case  valvular  lesions  may 
be  suspected ;  again,  excessive  use  of  tea,  coffee  or  tobacco 
may  be  found  to  be  contributing  causes,  in  which  event  the 
affection  of  the  heart  would  in  all  probability  be  a  neurosis. 

While  thus  recognizing  the  almost  constant  occurrence  of 
spinal  lesions  as  etiological  factors  in  the  production  of  dis- 
ease, the  contributing  causes  must  never  be  overlooked  since 
they  are  what  directly  produces  the  morbid  process  in  most 
instances. 

As  already  mentioned,  vertebral  subluxations  predispose 
those  parts  innervated  by  the  impinged  nerves  to  disease.  The 
contributing  causes  determine  which  of  these  parts  will  be- 
come affected  and  the  nature  of  the  affection.  Briefly  stated, 
therefore  the  proposition  is  this:  Given  a  vertebral  subluxa- 
tion, disease  is  made  possible ;  given  a  contributing  cause  its 
occurrence  is  made  certain.  Both  factors  must  be  present  in 
most  cases. 

Reference  has  already  been  made  in  the  chapter  on  spinal 
diagnosis  in  respect  to  the  impossibility  of  making  a  correct 
diagnosis  from  the  spinal  analysis  alone.  The  spinal  analysis 
determines  in  what  part,  organ,  or  system  of  the  body  a  dis- 
ease process  may  be  presumed  to  exist.  It  does  not,  however, 
give  any  clue  as  to  the  exact  nature  of  the  disease. 

Thus,  if  a  subluxation  is  found  in  the  lower  lumbar  region, 
disease  of  the  uterus  may  be  suspected.  But  whether  it  be 
endometritis  or  cancer  only  the  symptoms  present  will  deter- 
mine. For  this  reason  a  mental  picture  of  the  symptom-com- 
plex of  every  disease  is  essential.  If  the  practitioner  will, 
therefore,  familiarize  himself  first  with  the  innervation  of  the 
various  parts  of  the  body,  the  spinal  analysis  will  at  once 
show  him  what  organ  is  affected;  a  consideration  of  the 
symptoms  and  signs  present  then  determine  the  exact  nature 
of  the  affection.  For  this  reason  the  leading  symptoms  of  all 
the  diseases  given  are  included,  since  only  by  a  ready 
familiarity  therewith  is  accuracy  in  diagnosis  made  possible. 

It  may  be  asked,  why,  if  the  vertebral  subluxations  are  the 
primary  and  predisposing  cause  of  a  certain  disease,  will  ad- 
justment of  the  subluxated  vertebra  not  of  itself  cure  such  a 


VERTEBRAL  SUBLUXATIONS  387 

disease?     Why,   on   the   other   hand,   are   accessory   methods 
recommended? 

Adjunct  measures  are  used  in  the  treatment  of  some  dis- 
eases for  the  following  reasons:  1.  They  increase  or  add  to 
the  effectiveness  of  the  spinal  adjustment.  For  example,  in 
chronic  constipation,  while  the  restoration  of  the  nerve-supply 
of  the  bowel  is  accomplished  by  adjustment  of  the  subluxated 
vertebrae,  massage  is  recommended  to  assist  the  bowels  in 
evacuating  their  contents  until  their  muscular  coat  has  re- 
gained its  normal  tone ;  correction  of  the  diet  is  necessary 
to  make  the  work  of  the  intestines  as  light  as  possible  during 
the  period  when  extra  demands  are  being  put  upon  them. 
Exercises  are  valuable  in  building  up  the  muscular  structures 
of  the  body  and  consequently  also  of  the  abdominal  walls  and 
intestines.  During  these  treatments  spinal  adjustment  is 
continued,  and  is  the  prime  factor  in  the  restoration  of  normal 
function.  The  fact  that  other  methods  are  used  in  connec- 
tion therewith  does  not  detract  from  the  merits  of  the  spinal 
adjustment,  since  these  adjunct  measures  are  merely  as- 
sistive agents,  in  any  case,  in  the  same  manner  that  drugs 
are,  be  it  constipation  or  any  other  disease. 

2.  Adjunct  measures  are  used  for  the  elimination  of  the 
contributing  causes.  For  example,  if  the  patient  is  suffering 
from  Bright's  disease,  the  contributing  causes  must  be  recog- 
nized and  attention  given  them.  It  is  evidently  not  sufficient 
in  a  case  of  this  kind  to  adjust  the  tenth  to  twelfth  dorsal 
vertebrae.  This  has  been  done  many  times,  and  no  results 
obtained;  and  yet  we  know  that  the  nerves  emanating  from 
these  spinal  segments  influence  the  kidneys  more  than  any 
others.  For  this  reason  a  careful  spinal  analysis  should  be 
made  in  all  cases  to  determine  the  existence  of  subluxations 
elsewhere.  It  would  be  manifestly  folly  to  permit  a  patient 
with  Bright's  disease  to  eat  irritating  foods,  one  suffering 
from  heart  disease  to  exercise  violently,  or  one  having  cir- 
rhosis of  the  liver  to  use  alcohol.  On  the  other  hand,  a  proper 
diet  should  be  prescribed,  moderate  exercises  advised,  and 
liquors  interdicted  in  each  case  respectively. 

3.  Nearly  all  diseases  are  accompanied  by  a  greater  or 
less  toxemia  of  some  kind  or  nature.  It  is  true  that  restora- 
tion of  the  functional  activity  of  the  secretory  and  excretory 


388  SPINAL  ADJUSTMENT 

organs  through  spinal  adjustment  will  ultimately  rid  the 
organism  of  these  toxins.  Nevertheless,  accessory  methods 
greatly  assist  a  more  rapid  elimination  of  the  toxins  and 
make  the  spinal  adjustment  so  much  more  effective.  In  many 
acute  diseases  it  is  the  toxemia  which  produces  dangerous 
symptoms,  and  speedy  elimination  is  absolutely  necessary. 
For  this  reason,  adjustment  at  the  tenth  dorsal  segment  which 
stimulates  the  kidneys,  and  at  the  upper  lumbar  segments 
which  influence  the  bowels,  is  advised  in  such  conditions.  In 
connection  therewith  hot  baths,  hot  enemata,  etc  ,  are  given 
to  still  further  increase  the  eliminative  function  of  the  skin 
and  bowels. 

4.  Dangerous  symptoms  may  arise  at  any  time  in  the 
course  of  some  diseases,  and  even  result  in  the  patient's  death 
before  the  cause  can  possibly  be  corrected,  and  the  dangers 
obviated,  by  spinal  adjustment.  The  temperature  in  an  acute 
disease,  as  typhoid  fever,  may  rise  to  a  degree  that  may 
menace  the  life  of  the  patient.  This  fever  is  due  to  an  un- 
usually virulent  toxemia  and  immediate  steps  must  be  taken, 
to  employ  not  only  spinal  adjustments,  but  eliminative  meas- 
ures, and  combine  these  with  methods  directed  against  the 
fever  itself,  namely  cold  baths,  sponges,  compresses,  etc. 
Various  symptoms  must  be  given  appropriate  treatment,  the 
above  being  an  example  illustrating  the  necessity  for  using 
adjunct  measures. 

5.  Other  measures  of  treatment  have  shown  their  effec- 
tiveness in  different  diseases,  and  should  therefore  be  used. 
Spinal  adjustment  is  not  to  be  regarded  as  all  in  all  in  the 
treatment  of  disease  and  other  measures  which  are  of  proven 
value  should  be  considered.  Such  measures  as  massage, 
hydrotherapy,  spinal  concussion,  elimination,  diet,  exercises, 
etc.,  may  be  successfully  combined  with  spinal  adjustment. 
Reasons  for  the  desirability  of  using  some  of  these  adjunct 
measures  have  been  given  above.  These  illustrations  should 
serve  to  show  that  their  use  is  a  rational  and  logical  procedure, 
yet  does  not  detract  in  the  slightest  from  the  merits  of  spinal 
adjustment. 

6.  Lastly,  there  are  certain  diseases  and  conditions  that 
are  impossible  of  cure  by  any  known  method  of  treatment  and 
it  would  therefore  be  folly  to  employ  spinal  adjustment  in 


VERTEBRAL  SUBLUXATIONS  389 

them.  Such  diseases  as  advanced  tuberculosis,  cancer,  etc., 
are  accompanied  by  such  profound  destruction  of  tissue  ele- 
ments that  recovery  is  impossible.  Not  only  the  organs  pri- 
marily affected,  but  the  entire  "house  in  which  we  live"  is 
falling  to  pieces,  and  nothing  can  replace  that  which  has 
been  destroyed. 

There  are  other  conditions  which  belong  so  manifestly  in 
the  realm  of  surgery  that  attempts  to  relieve  them  by 
spinal  adjustment  alone  are  irrational  and  ill-conceived, 
and  show  an  ignorance  of  pathology.  Most  tumors,  for  in- 
stance, are  amenable  to  no  treatment  other  than  excision. 

With  all  these  facts  in  mind,  it  remains  true,  as  clinical 
results  conclusively  show,  that  of  all  methods  of  treatment 
of  disease.  Spinal  Adjustment  is  the  most  valuable  single 
measure  known. 


CHAPTER  II 

Infectious  Diseases 
Typhoid  Fever 

Etiology. — The  direct  and  secondary  cause  is  the  bacillus 
typhosus,  while  the  indirect  but  primary  cause  is  subluxation 
of  the  vertebrae,  which  prevents  the  conduction  of  nerve  im- 
pulses to  the  intestines,  thus  lowering  their  resistance  and 
permitting  the  growth  of  the  bacilli  and  the  elaboration  of 
their  toxins.  Contributing  etiological  factors  are  adolescence, 
temperate  climate,  spring  and  autumn  months,  contaminated 
water  and  milk. 

Pathology. — The  Peyer's  patches  undergo  enlargement, 
death,  ulceration,  and  finally  scar-formation.  The  lower  part 
of  the  small  intestine  and  the  upper  portion  of  the  large 
intestine  are  principally  affected.  Enlargement  of  the  spleen 
and  mesenteric  glands  is  present. 

Symptoms. — The  onset  is  gradual,  lasting  about  two 
weeks,  during  which  time  there  may  be  headache,  malaise, 
loss  of  appetite,  and  nose-bleed.  Sometimes  the  disease  be- 
gins as  meningitis,  or  pneumonia,  or  acute  Bright's  disease. 
The  diagnosis  is  sometimes  difficult,  in  these  cases.  FIRST 
WEEK — Fever,  which  in  typical  cases  rises  gradually,  being 
a  degree  higher  each  day,  while  the  morning  temperature  is 
one  degree  lower  than  that  of  the  preceding  evening.  The 
abdomen  is  distended,  tender,  and  bubbling  and  gurgling  on 
the  right  side  is  frequent.  Cough  is  common.  Headache  is 
constant  and  severe.  The  pulse  is  dicrotic.  There  may  be 
diarrhea.  SECOND  WEEK — The  symptoms  of  the  first 
week  continue,  and  are  aggravated.  Rose-spots  appear  upon 
the  abdomen  and  chest,  and  rarely  over  the  entire  body.  These 
spots  are  very  small,  slightly  raised,  bright  red,  and  disappear 
on  pressure.  The  fever  is  continuously  high,  103°  to  106° 
and  about  one  degree  lower  in  the  morning  than  in  the 
evening.     The  spleen  is  enlarged.     The  pulse  is  feeble,  but 

390 


INFECTIOUS  ])ISF-:ASKS  391 

relatively  slow,  around  100,  and  not  at  all  in  proportion  to  the 
height  of  the  fever,  which  is  characteristic.  The  tongue  is 
coated  except  at  the  tip  and  edges,  where  it  has  a  red,  glossy 
appearance.  The  nervous  symptoms  include  delirium,  stupor, 
mental  apathy  and  in  severe  cases,  the  "typhoid  state,"  which 
is  a  condition  of  profound  collapse.  The  more  violent  the 
delirium,  the  better  the  prognosis,  while  the  outlook  in  a 
patient  with  low,  muttering  delirium  is  bad.  THIRD  WEEK 
— The  fever  gradually  falls,  but  the  general  weakness  is  in- 
creased. There  is  emaciation,  rapid  pulse,  and  spasms  of 
the  muscles.  The  general  condition,  however,  is  marked  by 
gradual  improvement.  But  in  the  worst  cases  the  symptoms 
of  the  second  week  continue  and  become  progressively  worse. 
FOURTH  WEEK — Convalescence  commences,  and  the 
symptoms  gradually  disappear.  Other  less  common  symp- 
toms occurring  during  the  course  of  the  disease  include  per- 
spiration, jaundice,  hemorrhages,  erythema,  hiccough,  and 
persistence  of  the  appetite.  The  temperature  may  be  of  any 
kind  or  type. 

There  is  present  marked  tenderness  of  the  twelfth  pair  of 
thoracic  nerves,  especially  the  one  on  the  right  side.  This 
is  due  to  the  pathological  condition  of  the  lower  portion  of 
the  ileum,  which  receives  its  innervation  from  the  eighth 
segment  of  the  spinal  cord,  and  which  nerves  make  their 
exit  between  the  twelfth  thoracic  and  first  lumbar  vertebrae. 
There  is  contraction  of  the  ligaments  on  the  right  side  of  the 
twelfth  thoracic  segment,  marked  tenderness  of  the  twelfth 
thoracic  nerve  on  the  right  side,  and  increase  of  tempera- 
ture of  this  segment,  owing  to  the  pathological  changes  in 
Peyer's  patches.  There  is  tenderness  of  the  nerve  at  the 
sixth  thoracic  spinal  segment  on  the  left  side,  contraction 
of  the  ligaments  and  increased  temperature,  owing  to  the 
involvement  of  the  spleen. 

Treatment. — When  the  case  is  seen  early,  all  the  symp- 
toms enumerated  above  usually  do  not  develop,  unless  the 
infection  is  exceptionally  virulent  or  the  vital  resistance  of 
the  patient  is  very  low.  Adjust  the  atlas  to  relieve  nervous 
symptoms;  the  fifth  cervical  for  stimulation  of  the  innerva- 
tion to  the  thyroid  glands;  the  sixth  thoracic  for  its  eflfect 
upon  the  spleen;  the  eighth,  tenth  and  twelfth  thoracic  for 


392  SPINAL  ADJUSTMENT 

their  effect  upon  the  intestines  and  the  second  kimbar,  if  so 
indicated.     Adjust  the  cervicals  for  the  fever. 

Accessory  Treatment. — When  the  disease  is  first  sus- 
pected, the  patient,  after  having  been  properly  adjusted,  is 
given  a  bath,  put  to  bed,  given  an  enema,  put  on  a  liquid  diet, 
and  an  ice-cap  placed  on  the  head.  The  patient  should  not 
leave  the  bed  until  recovery  is  complete.  Every  morning  a 
bath  is  given,  the  back  is  sponged  with  alcohol,  and  dusted 
with  talcum  powder  to  prevent  development  of  bed-sores.  In 
cases  with  marked  delirium  or  high  fever,  different  kinds  of 
baths  are  valuable.  -The  cold  tub,  the  sponge  bath,  the  cold 
pack  and  the  alcohol  sponge  are  all  useful.  The  kind  of  bath 
depends  upon  the  strength  of  the  patient,  and  the  severity 
of  the  nervous  symptoms.  If  the  temperature  is  not  above 
103°,  baths  may  be  discontinued.  If  the  temperature  is  high 
only  in  the  evening,  and  the  nervous  symptoms  are  not  severe, 
a  cold  sponge  during  the  course  of  the  night  will  suffice. 
In  grave  cases,  the  sponge  bath,  or  any  of  the  other  varie- 
ties of  baths,  can  be  employed.  It  is  advisable  to  give  baths 
not  oftener  than  every  three  hours  in  any  case.  The  water 
should  be  about  80°,  and  the  patient  should  remain  in  the 
bath  not  longer  than  twenty  minutes.  Vigorous  massage  of 
the  extremities  adds  to  the  efficacy  of  the  bath.  It  is  not 
advisable  to  move  the  patient  to  any  extent. 

Diet. — Thin  meat  broth  or  milk  every  three  hours,  about 
a  cupful  at  a  time.  Water  should  be  taken  in  large  quantities. 
Other  articles  permitted  during  the  height  of  the  fever  are 
lemonade,  water  with  a  little  white  of  egg  added,  buttermilk, 
orange  juice,  and  purees  of  barley,  oat-meal  and  rice.  When 
the  temperature  goes  down,  one  or  two  egg-nogs  a  day  may 
be  given.  If  the  bowels  do  not  move  during  the  day,  give  an 
enema  of  soap-suds.  For  diarrhea,  change  the  diet;  if  milk 
is  being  given,  boil  it ;  or  change  to  meat  broths,  if  diarrhea 
persists. 

Small-Pox 

Etiology. — The  primary  and  indirect  cause  is  a  low  state 
of  vital  resistance  as  a  result  of  faulty  innervation.  This 
permits  the  growth  of  the  organisms  and  the  elaboration  of 
their  toxins  in  the  system  to  take  place.  The  direct  and 
secondary  cause   is   probably  an   intra-cellular  parasitic   pro- 


INFECTIOUS  DISEASES  393 

tozoon,  the  Cyloryctes  variolae.  There  is  no  period  from  the 
initial  fever  to  the  period  of  peeling  when  the  disease  is  not 
contagious,  although  during  the  stage  of  suppuration  the 
disease  is  most  communicable. 

Pathology. — The  eruption  with  its  four  stages,  namely, 
macule,  papule,  vesicle  and  pustule,  is  the  only  distinctive 
pathology.  A  depressed  spot  in  the  apex  of  the  pustule  indi- 
cates the  area  of  necrosis.  Granular  and  fatty  degeneration  of 
the  liver,  spleen,  heart  and  kidneys  is  present.  The  pustules 
sometimes  are  seen  in  the  larynx,  trachea,  bronchial  tubes, 
and  pleura. 

Symptoms. — There  is  an  incubation  period  of  from  ten 
to  fifteen  days.  The  onset  is  sudden  with  a  chill,  vomiting, 
and  severe  pain  in  the  head  and  back.  The  initial  rash  ap- 
pears on  the  first  or  second  day  and  resembles  that  of  measles 
or  scarlet  fever ;  this  rash  appears  principally  on  the  inner 
surfaces  of  the  thighs.  On  the  fourth  day  of  the  disease,  the 
true  eruption  of  small-pox  appears,  on  the  forehead,  wrists, 
back  and  elsewhere,  as  macules  having  a  hard  shotty  feel.  On 
the  fifth  and  sixth  day  these  change  to  vesicles,  the  apex  of 
which  is  sunken,  and  which  do  not  collapse  when  pricked 
with  a  needle.  On  the  eighth  day  pustules  appear,  surrounded 
by  a  red  zone.  On  the  eleventh  day  crusts  form,  which  later 
fall  oflf.  The  initial  fever  rapidly  rises  to  103°-104°,  with  a 
drop  to  normal  from  the  fourth  to  the  eighth  day.  When  the 
true  eruption  appears,  a  secondary  rise  of  temperature  oc- 
curs. Constitutional  disturbances  are  severe,  and  delirium 
and  the  "typhoid  state"  frequently  are  met  with.  Tenderness 
of  the  nerves  of  the  fifth  and  seventh  thoracic  segments  is 
present  in  nearly  all  cases  of  small-pox. 

Treatment. — Adjust  the  fifth  cer\^ical  and  the  fifth  or  sixth 
and  tenth  thoracic  vertebrae.  Adjustment  of  the  fifth  cer\'ical 
vertebra  is  claimed  by  some  to  be  a  specific  in  the  treatment 
of  small-pox.  The  diet  should  consist  of  milk,  broths,  and 
other  easily  digestible  foods.  For  fever  and  nervous  symptoms 
use  cold  baths  or  sponges. 

Varicella  (Chicken-Pox) 

Etiology.— The  direct  cause  of  this  disease  is  unknown. 
Being  of  an  infectious  and  contagious  nature,  however,  it  may 


394  SPINAL  ADJUSTMENT 

be   correctly   assumed   that   the   primary   and    indirect   cause 
is  a  state  of  impaired  resistance,  due  to  faulty  innervation. 

Symptoms. — The  incubation  period  is  from  ten  to  four- 
teen days.  The  onset  is  sudden,  with  vomiting  and  backache 
at  times.  A  moderate  rise  in  temperature.  The  eruption, 
at  first  papular,  soon  becomes  vesicular.  The  vesicles  appear 
on  the  first  day  of  the  disease,  and  are  commonly  single, 
distributed  over  the  entire  body,  few  in  number,  and  collapse 
on  pricking  with  a  needle.  On  the  third  or  fourth  day  pustules 
appear,  which  soon  dry  up  and  form  brownish  crusts. 

Treatment. — Adjust  the  fifth  cervical  and  fifth  and  tenth 
thoracic  vertebrae.  The  disease  always  terminates  favorably 
under  this  mode  of  treatment.  Otherwise  the  therapy  is 
symptomatic. 

Scarlet  Fever 

Etiology. — The  direct  and  secondary  cause  is  a  special 
micro-organism,  which  retains  its  infecting  power  for  at 
least  one  year.  The  poison  is  scattered  by  the  scales  in  the 
air,  clothes,  food,  etc.  The  respiratory  tract  is  generally  the 
atrium  of  infection,  but  the  digestive  tract  may  also  convey 
the  poison.  Children  are  most  susceptible  to  this  disease. 
Second  attacks  are  unusual,  but  do  occur.  The  indirect  and 
primary  cause  is  a  lack  of  resistance  due  to  faulty  innervation, 
as  a  result  of  vertebral  subluxations. 

Pathology. — There  is  no  characteristic  morbid  anatomy. 
The  skin  is  the  seat  of  acute  inflammation  which  fades  away. 
There  is  granular  degeneration  of  the  liver,  spleen,  stom- 
ach, kidneys,  heart  and  muscles.  The  throat  is  the  seat  of 
inflammation,  and  sometimes  ulceration. 

Symptoms. — The  incubation  period  varies  from  two  to 
four  days.  The  onset  is  sudden,  often  with  a  chill,  vomiting, 
and  spasms.  The  condition  of  the  throat  varies  from  a  mild 
angina  to  severe  ulceration.  The  eruption  appears  on  the 
first  or  second  day,  and  resembles  a  vivid  red  blush ;  it  first 
invades  the  neck,  chest  and  arms,  and  then  becomes  general ; 
a  characteristic  feature  is  that  a  portion  of  the  face  about  the 
mouth  is  not  covered  by  the  eruption  and  appears  very  white 
in  contrast  with  the  balance  of  the  face.  It  fades  rapidly,  and 
it  may  be  quite  itchy.  The  peeling  is  characteristrc,  and  be- 
gins soon  after  the  eruption  disappears.     It  is  fine  and  scaly 


INFFXTIOUS  DISEASES  395 

on  the  body,  but  from  the  feet  and  hands  whole  casts  may 
come  off;  it  lasts  two  weeks  or  more.  The  fever  rises  rapidly 
to  103°-106°,  and  there  is  rapid  pulse  and  often  delirium.  It 
falls  to  normal  in  from  three  to  ten  days.  The  tongue  has  the 
appearance  of  a  strawberry,  showing  enlarged  fungiform 
papillae.  The  cervical  glands  are  enlarged.  Acute  Bright's 
disease  is  apt  to  develop  from  the  3rd  week,  and  the  urine 
contain  albumin.  In  all  cases  the  kidneys  are  affected  early. 
If,  however,  albumin  is  still  present  in  the  urine  after  the 
third  week,  permanent  kidney  trouble  will  probably  result. 
Complications  and  sequelae  include  nephritis,  middle  ear 
disease.  Arthritis,  Endocarditis,  Myocarditis,  Pericarditis, 
Pleurisy,  Ludwig's  angina.  Broncho-pneumonia,  Chorea, 
Paralyses,  and  Noma. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  and  10th 
thoracic  vertebrae,  and  make  any  other  adjustments  which 
may  be  indicated,  after  a  careful  spinal  analysis  has  been  made. 
Strict  quarantine  until  desquamation  is  complete.  The  patient 
should  be  isolated.  Disinfecting  measures  to  the  saliva  and 
peeled  skin.  Diet  should  consist  of  milk.  An  abundance  of 
water  should  be  drunk,  to  relieve  the  work  of  the  kidneys  as 
far  as  possible.  Apply  olive  oil  or  carbolated  vaseline  to  the 
skin  when  peeling  commences  to  prevent  scattering  of  the 
scales.  Supportive  measures  as  required.  The  patient  should 
not  be  allowed  to  leave  the  bed,  until  after  the  third  week  on 
account  of  the  danger  of  complications,  especially  Bright's 
disease. 

Measles 

Etiology. — The  cause  is  an  unknown  microorganism, 
which  may  be  transmitted  through  a  third  party,  and  in  various 
other  ways.  It  is  seen  usually  in  children,  although  adults 
sometimes  contract  it.  It  is  generally  epidemic.  Second  at- 
tacks are  uncommon,  but  may  occur. 

Pathology. — No  characteristic  lesions  are  present.  The 
kidneys  may  be  the  seat  of  albuminous  degeneration  or  acute 
nephritis.  Bronchopneumonia  or  enlargement  of  the  bron- 
chial lymph  glands  may  develop. 

Symptoms. — The  incubation  period  varies  from  ten  to 
fourteen  days.  The  onset  of  the  disease  is  sudden,  a  chill  or 
chilliness,  fever  of  101°  to  102°  F.,  muscular  soreness,  head- 


396  SPINAL  ADJUSTMENT 

ache,  and  intense  catarrh  of  the  nose  and  throat,  being  the 
first  symptoms.  There  are  present  also  redness  of  the  eyes, 
aversion  to  light,  sneezing  and  coughing.  On  the  second  day 
the  fever  drops,  but  rises  again  on  the  fourth  day,  when  an 
eruption  of  small,  dark  red,  velvety  papules  appears,  first  on 
the  face,  and  rapidly  spreads  over  the  entire  body.  The 
catarrhal  symptoms  still  persist.  There  is  itching  and  burn- 
ing. On  about  the  ninth  day  the  rash  begins  to  fade  and 
soon  disappears  entirely  by  bran-like  desquamation.  Koplik's 
spots  which  are  bluish  white  spots  found  on  the  mucous  mem- 
brane of  the  cheeks,  are  supposed  to  be  pathognomonic  of 
measles.  Black  measles  is  that  variety  in  which  the  eruption 
is  hemorrhagic  and  there  is  great  prostration.  It  is  encoun- 
tered in  places  in  which  faulty  hygiene  exists. 

The  most  common  complications  are  catarrhal  pneumonia 
and  catarrh  of  the  stomach  and  intestines.  The  most  common 
sequelae  are  tonsillitis,  tuberculosis,  and  cancrum  oris. 

Treatment.- — Adjust  the  4th  and  6th  cervicals,  and  the  3rd, 
5th  and  10th  dorsals.  The  patient  should  be  kept  in  bed,  ki  a 
warm  but  well  ventilated  room.  The  eyes  should  be  kept 
clean  and  protected  from  the  light.  The  mouth  also  should 
be  frequently  cleansed.  For  high  fever,  sponging  or  tepid 
baths  gradually  cooled.  During  desquamation  oil  and  bathe 
the  skin.  Guard  the  patient  against  exposure  during  con- 
valescence, in  order  to  avoid  broncho-pneumonia  and  tuber- 
culosis. 

Rubella  (German  Measles) 

Etiology. — The  direct  cause  is  unknown.  The  disease  is 
seen  in  epidemic  form  most  often,  and  spreads  rapidly. 

Symptoms. — The  incubation  period  is  from  10  to  14  days. 
The  onset  is  sudden,  and  the  rash  appears  at  once,  and  con- 
sists of  bright  red  macules  and  papules.  The  cervical  lymph 
glands  are  often  enlarged.  Slight  rise  in  temperature.  Mild 
coryza  and  sore  throat. 

Treatment. — There  is  no  special  treatment ;  the  measures 
indicated  under  measles  are  applicable  to  this  disease. 

Epidemic  Parotitis   (Mumps) 
Etiology. — The  specific  cause  is  at  present  unknown.     It 
occurs  in   epidemic  form  although   sporadic  cases  are  seen. 


INFECTIOUS  DISEASES  397 

Females  are  less  susceptible  than  males,  and  the  disease  oc- 
curs most  commonly  between  the  ages  of  5  and  15  years. 

Pathology. — One  or  both  parotid  glands  are  inflamed  and 
in  severe  epidemics  the  cellular  tissue  of  the  gland  is  involved. 
The  inflammation  first  involves  the  gland  ducts  and  quickly 
extends  to  the  gland  proper.  Sometimes  the  submaxillary 
gland,  the  ovaries,  testes  and  mammary  glands  are  involved. 
Secondary  parotitis  occurs  as  a  complication  in  severe  blood- 
poisoning,  and  ends  in  suppuration  and  destruction  of  gland- 
structure. 

Symptoms. — The  incubation  period  lasts  from  2  to  3  weeks. 
The  onset  is  sudden  and  marked  by  mild  fever.  One  parotid 
gland  is  swollen  and  painful ;  two  or  three  days  after  the  op- 
posite gland  becomes  affected.  Dysphagia  and  often  earache ; 
inflammation  of  the  testes  in  the  adult  may  be  the  only  evi- 
dence of  the  disease,  which  lasts  about  one  week.  Orchitis 
is  the  most  common  sequel,  and  may  result  in  sterility.  Chronic 
enlargement  of  the  gland,  and  deafness  may  also  result. 

Treatment. — Give  adjustments  in  the  upper  cervical  region, 
since  from  here  is  derived  the  innervation  to  the  salivary 
glands ;  the  5th  dorsal  vertebra  should  be  adjusted,  since  from 
this  segment  there  seems  to  be  a  specific  influence  in  this 
disease.  The  disease,  if  treated  early  in  this  way,  may  be 
cut  short.  The  lower  dorsal  vertebrae  should  also  be  adjusted. 
Locally,  a  hot  compress  or  an  ice  bag  is  of  service.  Other- 
wise the  treatment  is  symptomatic. 

Whooping  Cough   (Pertussis) 

Etiology. — The  disease  is  contagious  and  is  due  to  an  un- 
known microorganism,  which  attacks  patients  of  low  vitality, 
the  primary  cause  of  which  is  disturbed  innervation.  It  is  a 
disease  of  childhood,  fully  one-half  of  the  cases  occurring  dur- 
ing the  first  two  years  of  life.  Adults  may,  however,  be  af- 
fected.    Second  attacks  are  uncommon. 

Pathology. — No  characteristic  lesions  are  present. 

Symptoms. — The  incubation  period  varies  from  1  to  2 
weeks.  For  the  first  one  or  two  weeks  there  is  cough,  which 
gradually  becomes  spasmodic.  Slight  fever,  and  coryza  then 
develop.  This  stage  is  followed  by  the  characteristic  whoop, 
which  is  a  sharp,  inspiratory  sound  following  a  series  of  short 


398  SPINAL  ADJUSTMENT 

expiratory  coughs.  Such  paroxysms  occur  many  times  a  day, 
and  during  the  paroxysm  the  face  becomes  blue,  the  eyeballs 
protrude,  and  an  anxious  expression  of  the  face  is  present 
and  involuntary  urination  occurs.  Loss  of  weight  and 
strength,  and  anemia  often  follow.  Nearly  all  forms  of  lung 
diseases  may  occur  as  complications  of,  or  sequelae  to, 
whooping  cough,  as  well  as  disorders  which  result  from 
the  violent  coughing,  as  apoplexy,  cardiac  dilatation,  and 
conjunctivitis. 

Treatment. — Adjust  the  4th  and  6th  cervical  for  the  relief 
of  the  catarrhal  symptoms.  Adjustment  of  the  3rd  and  5th 
dorsals  has  a  specific  action  on  this  disease,  and  if  this  treat- 
ment is  given  at  the  onset  of  the  disease,  will  serve  to  cut  it 
short.  The  patient  should  be  isolated  if  possible;  in  severe 
cases  rest  in  bed  is  indicated. 

Influenza  (La  Grippe) 

Etiology. — The  direct  and  secondary  cause  is  the  influenza 
bacillus  (Pfeififer).  The  indirect  and  primary  cause  is  faulty 
resistance,  due  to  improper  innervation,  and  it  is  only  in  the 
presence  of  such  a  state  of  depleted  vitality  that  the  disease 
can  develop. 

Pathology. — No  characteristic  lesions  are  present.  Some- 
times an  exudative  inflammation  of  the  respiratory,  nervous 
and  digestive  systems  is  present. 

Symptoms. — The  incubation  period  lasts  from  three  to 
four  days.  The  onset  is  usually  sudden,  with  a  chill  and  all 
symptoms  of  a  fever  due  to  a  general  infection.  The  symp- 
toms depend  upon  the  region  affected.  There  are  several 
forms  of  Influenza,  among  which  the  following  are  the  most 
common :  (a)  The  Respiratory  form,  which  begins  like  a 
severe  coryza,  with  fever,  pain  in  the  eyes,  backache,  pains 
in  the  extremities,  and  profound  prostration.  Symptoms  of 
bronchitis,  pleurisy,  or  pneumonia  may  develop,  (b)  The 
Nervous  form,  in  which  the  characteristic  symptoms  are 
severe  headache,  pain  in  the  back  and  extremities,  and  pros- 
tration. The  disease  may,  however,  be  so  severe  that  symp- 
toms of  meningitis,  neuritis,  and  mental  disorders  develop, 
(c)  Gastro-Intestinal  form,  which  begins  with  symptoms  of 
acute  gastritis,  namely,  nausea,  vomiting,  epigastric  pain  and 


INFECTIOUS  DISEASES  399 

fever;  or  of  acute  colitis,   namely   fever,  colic,  diarrhea  and 
occasionally  jaundice. 

Treatment. — Adjust  the  4th  cervical  and  the  3rd,  5th,  7th 
and  10th  dorsal  vertebrae.  Concussion  over  the  7th  cervical 
may  abort  the  attack.  The  patient  should  remain  in  bed  in 
a  v^arm,  well-ventilated  room ;  the  bowels  should  be  regulated. 
Liquid  diet.     Hot  baths  to  induce  free  perspiration. 

Erysipelas 

Etiology. — The  direct  cause  is  the  Streptococous  erysipela- 
tus;  the  primary  and  indirect  cause  is  vertebral  subluxations, 
which,  by  diminishing  the  innervation,  produce  a  low  grade 
of  vital  resistance.  The  disease  is  seen  most  commonly  in 
March  and  April,  in  alcoholics,  or  patients  having  Bright's 
disease. 

Pathology. — The  involved  skin  is  inflamed,  thickened  and 
edematous.  Suppuration  or  gangrene  of  the  skin  may  develop ; 
meningitis  from  extension ;  and  involvement  of  various  viscera. 

Symptoms. — The  incubation  period  is  from  3  to  7  days. 
The  onset  is  sudden,  with  a  chill.  The  eruption  is  a  bright 
red  flush  and  its  margin  is  raised  and  clean-cut.  The  eruption 
commences  on  the  bridge  of  the  nose  and  to  either  side  of  it, 
and  extends  to  the  mouth,  ears,  neck  and  even  the  arms.  The 
face  is  disfigured ;  the  eye-balls  are  swollen,  and  the  con- 
junctiva is  inflamed ;  the  skin  is  hard  and  edematous,  and 
large  blisters  may  form.  The  temperature  is  raised  to  104°  or 
even  106°.  The  disease  lasts  4  or  5  days,  when  the  fever  falls 
by  crisis ;  if  however,  the  area  affected  is  large,  the  disease 
is  prolonged  for  some  time. 

Treatment. — Adjust  in  accordance  with  the  location  of 
the  disease ;  adjust  the  10th  dorsal  vertebra  in  all  cases.  Com- 
presses should  be  applied  to  the  aflfected  parts.  The  bowels 
should  be  regulated.  Liquid  diet.  The  fever  can  be  reduced 
by  cold  sponging. 

Rheumatic  Fever  (Acute  Articular  Rheumatism) 
Etiology. — The  primary  cause  of  rheumatic  fever  is  faulty 
innervation  first  of  the  tonsils  which  makes  them  a  favorable 
culture  medium  for  the  bacteria  which  are  the  direct  cause  of 
the  disease;  second,  the  nervous  system  in  general  may  be 
disturbed ;  third,  subluxations  present  may  result  in  defective 


400  SPINAL  ADJUSTMENT 

metabolism  with  consequent  accumulation  in  the  body  of 
poisonous  substances. 

Pathology. — The  affected  joints  are  markedly  hyperemic 
and  the  synovial  membrane  and  surrounding  ligaments  are 
swollen.  Erosions  of  the  cartilages.  Edema  of  the  joint  and 
surrounding  structures  occasions  considerable  swelling  and 
the  pain  is  no  doubt  due  to  the  stretching  of  the  tissues  and 
pressure  on  the  nerves. 

Symptoms. — The  disease  commences  suddenly,  with  a  rise 
in  temperature  to  103°-105°.  The  affected  joints  are  red, 
swollen,  intensely  painful  and  tender.  A  characteristic  fea- 
ture is  the  migration  from  one  joint  to  another.  Acid  sweats, 
which  produce  tiny  vesicles.  The  urine  contains  a  heavy 
sediment  of  urates.  Skin  eruptions  are  common.  There  is  a 
tendency  to  recurrence.  Simple  Endocarditis  is  a  very  com- 
mon complication.  Myocarditis  and  Pericarditis  are  sequelae. 
The  disease  may  be  complicated  by  pneumonia,  Bright's 
disease,  or  chorea,  or  may  merge  into  the  chronic  form  if  re- 
flex vertebral  subluxations  are  not  corrected;  these  lesions 
invariably  occur  in  the  spinal  segment  which  controls  the 
affected  joint. 

Treatment. — Adjust  the  5th  and  10th  dorsals,  and  also  the 
segments  controlling  the  parts  which  are  affected.  This  will 
cause  a  favorable  termination,  prevent  chronic  rheumatism, 
and  obviate  complications.  One  of  the  most  effective  remedies 
in  acute  articular  rheumatism  is  the  application  of  hot  packs 
over  the  affected  joints.  In  all  cases  the  patient  should  be 
placed  at  absolute  rest  in  bed.  He  should  wear  woolen  gar- 
ments, and  blankets  should  be  used,  care  being  taken  to  pro- 
tect the  inflamed  joint  from  excessive  weight  of  the  coverings, 
by  using  a  tent.  The  diet  should  consist  of  easily  digested 
substances,  preferably  milk.  Water,  especially  the  alkaline 
mineral  waters,  should  be  freely  used.  After  the  process  has 
become  subacute,  warm  baths,  together  with  cautious  mas- 
sage are  often  helpful  in  removing  the  stiffness  of  the  joints. 

Dysentery   (Bloody  Flux) 

Etiology. — The  primary  cause  of  this  disease  is  vertebral 
subluxations  in  the  lumbar  region,  which,  by  interfering  with 
the  innervation  of  the  intestine,  render  it  susceptible  to  the 


INFECTIOUS  DISEASES  401 

invasion  of  the  contributing  causes,  which  are  most  com- 
monly errors  in  diet,  impure  drinking  water,  sudden  changes 
in  temperature,  and  faulty  hygiene.  It  occurs  most  frequently 
during  the  summer  and  autumn  months,  and  in  tropical 
climates. 

Pathology. — Inflammation,  enlargement  of  the  lymph 
follicles,  excessive  secretion  of  mucus,  and  sometimes  ulcera- 
tion of  the  large  bowel. 

Symptoms. — The  incubation  period  is  one  or  two  days. 
The  onset  is  sudden,  with  fever,  pain  in  the  abdomen,  and 
diarrhea.  The  stools  contain  mucus  and  later  blood ;  they 
become  very  frequent,  with  extreme  thirst,  and  violent  pain. 
The  fever  may  be  103°  to  104°.  The  acute  catarrhal  dysentery 
is  the  mild  variety.  Diphtheritic  dysentery  is  a  type  in  which 
there  is  great  congestion  and  necrosis  of  the  lining  of  the  in- 
testine, and  it  often  follows  other  diseases,  as  pneumonia, 
heart  disease,  and  Bright's  disease. 

Treatment. — Adjust  the  10th  dorsal  and  2nd  lumbar  ver- 
tebrae. Rectal  dilatation  is  very  useful  in  the  chronic  forms. 
The  patient  should  be  continuously  confined  to  bed  in  even 
the  mildest  attacks.  The  discharges  should  be  disinfected. 
The  diet  should  be  bland  and  unirritating.  Substances  such 
as  milk  and  lime-water,  broths  and  egg-albumin  should  be 
given  in  acute  attacks.  In  chronic  cases  the  diet  may  be  semi- 
solid. 

Tuberculosis 

Etiology. — The  direct  and  secondary  cause  is  the  tubercle 
bacillus.  The  indirect  and  primary  causes  are  spinal  lesions, 
producing  faulty  innervation,  and  resulting  in  a  low  grade 
of  resistance.  Predisposing  causes  are  a  family  predisposi- 
tion ;  unhygienic  surroundings ;  debilitated  states ;  improper 
food ;  occupations  requiring  the  breathing  of  fine  particles  of 
dust  or  mineral  matter;  other  lung  diseases;  chronic  diseases 
of  all  kinds ;  trauma. 

Pathology. — The  characteristic  lesion  is  the  tubercle.  This 
is  usually  in  the  lungs  in  adults;  lymph  glands,  bones  and 
joints  in  children.  At  the  site  of  the  infection  the  germs 
multiply  rapidly;  at  the  same  time  leucocytes  gather  at  this 
point  and  the  cells  proliferate.  This  entire  mass  is  devoid  of 
blood-vessels  and  constitutes  the  tubercles  which  are  irregu- 


402  SPINAL  ADJUSTMENT 

larly  round,  pearly  and  gray.  The  action  of  the  germs  and 
their  toxins  and  the  absence  of  blood  supply  causes  the  center 
of  the  tubercle  to  become  necrotic  until  the  whole  is  con- 
verted into  a  yellowish,  cheesy  mass.  This  may  either  become 
encapsulated  and  calcified ;  or  the  process  may  continue  until 
cavities  are  formed  in  the  parts  afi^ected. 

Pulmonary  Tuberculosis  (Consumption;  Phthisis) 

There  are  four  varieties  of  Pulmonary  Tuberculosis:  1, 
Acute  miliary  tuberculosis ;  2,  Pneumonic  phthisis ;  3,  Tuber- 
cular phthisis ;  4,  Fibroid  phthisis. 

Acute  Miliary  Tuberculosis  (Acute  Phthisis;  Galloping  Consumption) 

Etiology. — In  the  majority  of  cases  it  is  the  result  of  an 
autoinfection,  arising  from  either  an  active  or  latent  tuber- 
culous focus  in  persons  of  a  low  grade  of  vital  resistance  due 
to  faulty  innervation.  It  sometimes  follows  measles,  whoop- 
ing cough,  small-pox,  and  la  grippe.  It  is  most  common  be- 
tween the  age  of  puberty  and  middle  life.  For  the  deposition 
through  the  body  of  the  tubercles,  under  the  influence  of  cer- 
tain forms  of  irritation,  it  is  essential  that  the  resistance  of 
the  patient  be  diminished. 

Pathology. — The  miliary  tubercle  consists  of  a  fine  net- 
work of  fibers,  containing  a  mass  of  cells  and  granules,  and 
often  having  a  giant  cell  for  its  center.  The  deposit  is  gen- 
erally over  both  lungs,  and  the  bronchial  tubes,  and  is  fol- 
lowed by  congestion,  a  viscid  secretion,  and  all  tissues  with 
which  it  comes  into  contact  are  destroyed. 

Symptoms. — Several  forms  are  met  with :  (a)  The  typhoid 
form,  in  which  the  fever  very  much  resembles  that  of  typhoid. 
The  other  symptoms  of  the  latter  disease  are,  however,  want- 
ing, (b)  The  meningeal  form,  in  which  symptoms  of  basal 
meningitis,  tubercular  meningitis,  and  hydrocephalus  are 
present,  (c)  The  Pulmonary  form,  in  which  the  usual  symp- 
toms of  tuberculosis  are  present  in  an  aggravated  form. 

Pneumonic  Phthisis  (Chronic  Catarrhal  Pneumonia) 

Etiology. — This  form  of  tuberculosis  is  dependent  pri- 
marily upon  a  low  resistance  which  permits  of  the  multiplica- 
tion of  the  tubercle  bacilli,  and  the  elaboration  of  their  toxins. 


INFECTIOUS  DISEASES  403 

Among  contributing  causes  may  be  mentioned  poor  hygienic 
surroundings,  a  scrofulous  tendency,  catarrhal  pneumonia, 
especially  at  the  apex  of  the  lung,  and  the  continuous  inhala- 
tion of  irritant  particles.  Sometimes  the  disease  follows  one 
of  the  acute  infectious  fevers. 

Pathology. — The  bronchioles  and  air  vesicles  are  filled  with 
a  cheesy  material,  which  is  a  necrotic  mass  of  dead  leucocytes, 
germs,  cells,  etc.  The  affected  areas  of  the  lung  soften  and 
are  converted  into  abscess  cavities.  The  process  is  situated 
most  commonly  at  the  apex  of  the  lung.  The  pleura  are  prone 
to  be  affected. 

Symptoms. — Pneumonic  phthisis  is  seen  in  three  forms: 
Acute,  subacute  and  chronic. 

The  acute  form  runs  a  very  rapid  course-,  beginning  either 
as  a  croupous  or  catarrhal  pneumonia,  which  aft'ects  one  whole 
lung  or  parts  of  each  lung,  and  is  accompanied  by  a  high  tem- 
perature ;  night-sweats ;  dyspnea ;  severe  cough ;  abundant 
purulent,  and  blood-streaked  expectoration ;  impaired  diges- 
tion and  loss  of  appetite ;  rapid  loss  of  flesh  and  strength. 

The  subacute  variety  is  generally  preceded  by  pneumonia 
of  one  or  two  weeks'  duration,  from  wdiich  the  patient  does 
not  entirely  recover.  After  a  few  weeks  or  months,  softening 
of  the  lung,  followed  by  destruction  and  the  formation  of 
cavities  occurs.  These  changes  are  accompanied  by  the  usual 
symptoms  of  pulmonary  tuberculosis,  and  in  untreated  cases 
the  course  is  about  one  year. 

The  chronic  form  commences  insidiously,  a  history  of 
previous  susceptibility  to  colds  and  catarrh  being  present. 
A  chronic  cough  with  muco-purulent  expectoration  develops, 
and  each  time  the  patient  has  a  "cold,"  fever,  pain  in  the 
chest,  and  mild  haemoptysis  accompany  it.  Finally  the  char- 
acteristic symptoms  of  tuberculosis,  namely  morning  chills, 
evening  rise  in  temperature,  profuse  night-sweats,  distressing 
cough  and  expectoration  are  present. 

Physical  Signs. — Inspection  shows  the  respiratory  move- 
ments over  diseased  portions  of  the  lungs,  increased  in  fre- 
quency and  diminished  in  force.  Palpation  over  consolidated 
areas  shows  increased  vocal  fremitus.  The  percussion  note 
at  the  apex  varies  from  slight  impairment  of  the  normal  note 
to  dulness,  and  when  cavities  are  formed  there  are  present 


404  SPINAL  ADJUSTMENT 

scattered  areas  over  which  the  tympanitic  or  hollow  note  is 
obtained.  When  the  cavities  are  filled  with  exudation  the 
percussion  note  will  be  dull,  but  after  expulsion  of  the  exudate, 
the  tympanitic  sound  is  again  obtained.  Auscultation  shows 
no  change ;  the  normal  vesicular  murmur  is  heard  in  those 
portions  of  the  lung  free  from  disease ;  the  respiratory  mur- 
mur is  feeble  if  many  bronchioles  are  obstructed,  and  harsh 
or  blowing  if  the  bronchioles  are  narrowed.  The  crepitant 
rale  is  also  heard.  If  bronchitis  is  present  subcrepitant  and 
mucous  rales  are  also  detected.  When  cavities  form,  bron- 
chial or  cavernous  respiration  is  heard,  associated  with  gur- 
gling rales.  If  the  cavity  is  empty,  and  has  walls  which  do 
not  collapse,  the  breathing  is  amphoric. 

Tubercular  Phthisis   (Tuberculosis;  Consumption;  Chronic  Phthisis) 

Etiology.- — As  in  other  forms  of  tuberculosis,  the  primary 
cause  is  a  low  grade  of  resistance  due  to  faulty  innervation 
of  the  respiratory  tract  which  is  the  atrium  of  the  infection. 
The  direct  cause,  when  such  favorable  conditions  obtain,  is 
the  tubercle  bacillus.  Contributing  factors  are  poor  hygienic 
surroundings,  family  predisposition,  and  exhausting  diseases. 

Pathology. — The  bronchial  glands  contain  numerous 
minute  tubercles,  and  cheesy  foci.  Adhesions  and  thickening 
of  the  pleurae.  There  is  often  a  serous,  purulent,  or  bloody 
effusion.  Pyopneumothorax  is  sometimes  present.  The 
lesions  in  the  lungs  are  generally  situated  at  the  apex.  Other 
organs,  especially  the  larynx  and  intestines  are  often  the  seat 
of  tuberculous  lesions. 

Symptoms.— The  symptoms  of  early  tuberculosis  are 
slight  fever,  every  evening,  increase  in  the  pulse-rate,  spitting 
of  blood,  bronchial  cough,  pains  in  the  thorax,  and  gastric 
disturbances.  As  the  disease  advances,  distressing  cough, 
which  becomes  worse,  and  expectoration,  which  at  first  is 
muco-purulent  and  later  becomes  yellowish  or  greenish. 
Dyspnea  becomes  more  marked  as  the  destruction  of  lung 
tissue  continues.  The  fever  which  at  first  is  moderate,  be- 
comes hectic,  and  is  accompanied  by  chills  and  sweats.  Chest 
pains  are  due  to  the  associated  pleurisy  and  violent  coughing. 
Later  still,  night  sweats  and  hemoptysis  become  severe. 
Progressive  loss  in  flesh  and  strength,  which  is  least  notice- 


INFECTIOUS  DISEASES  405 

able    upon    the    face.      Insomnia,    nausea    and    vomiting,    and 
diarrhea. 

The  earliest  physical  signs  are  a  slight  sinking  in  and  fail- 
ure of  expansion  of  the  upper  part  of  the  thorax ;  this  may  be 
so  slight  as  to  be  scarcely  noticeable  except  by  comparison 
with  the  healthy  side.  On  palpation  a  slight  diminution  of 
the  vocal  fremitus  is  detected.  On  percussion  the  normal 
vesicular  resonance  is  diminished.  On  auscultation  a  crepitant 
rale  is  heard ;  if  this  rale  is  present  day  after  day,  at  the  same 
spot,  for  a  period  of  two  weeks,  tuberculosis  may  be  strongly 
suspected.  These  signs  must  be  recognized,  as  only  an-  early 
diagnosis  of  tuberculosis  is  of  practical  value.  Later  on,  as 
consolidation  of  the  lung  becomes  more  marked,  all  the  above 
signs  are  increased.  Later  still,  when  cavity  formation  has 
commenced,  bubbling  rales  are  heard,  the  percussion  note  is 
tympanitic,  breathing  is  cavernous,  and  metallic  tinkling,  suc- 
cussion,  and  cracked-pot  resonance  may  all  be  present. 

Fibroid   Phthisis    (Chronic    Interstitial    Pneumonia;   Cirrhosis    of  the 

Lungs) 

Etiology. — The  primary  cause  is  faulty  resistance  while 
the  direct  cause  is  the  tubercle  bacillus.  Predisposing  factors 
are  occupation,  heredity,  and  previous  pulmonary  diseases, 
and  chronic  wasting  diseases,  which  by  the  production  of 
reflex  subluxations  in  the  segments  that  control  the  lungs, 
render  them  liable  to  tuberculosis  in  the  presence  of  the 
bacilli. 

Pathology. — Marked  development  of  fibrous  tissue  in  ad- 
dition to  the  tubercular  process  in  the  lung,  wnth  consequent 
shrinking  of  the  afifected  lung. 

Symptoms. — This  disease  commences  as  a  bronchial 
catarrh,  w^hich  is  worse  in  winter  and  better  in  summer,  and 
runs  a  chronic  course.  In  the  more  advanced  stages  of  this 
disease,  the  cough  is  more  persistent  and  the  expectoration 
more  abundant,  consisting  of  muco-purulent  material.  Later 
on  fever,  with  night-sweats,  and  dyspnea  and  rapid  emacia- 
tion develop.  Edema  of  the  ankles  is  a  late  symptom  and  is 
due  to  failure  of  the  circulation.  Inspection  shows  the  thorax 
retracted  on  the  afifected  side.  The  percussion  note  is  dimin- 
ished   in    resonance    or    dull.      Auscultation    shows    broncho- 


406  SPINAL  ADJUSTMENT 

vesicular  respiration,  and  suljcrepitant,  mucous  and  bubbling 
rales.     Later  on  bronchial  and  cavernous  breathing  are  heard. 

Treatment  of  Tuberculosis 

The  patient  should  sleep  alone,  in  a  well-ventilated  room. 
All  articles  soiled  by  the  sputum,  as  bed  linen,  eating  utensils, 
etc.,  should  be  disinfected.  Sputum  cups,  v^hich  may  be 
burned,  should  be  used.  The  patient  should  live  in  the  open 
air,  in  a  tent.  A  dry,  equable  climate  is  best,  as  in  Arizona, 
Colorado  and  New  Mexico.  If  unable  to  do  this,  sleeping  in  a 
tent  in'  the  yard,  sleeping  on  the  porch,  or  with  window  tents, 
may  be  substituted.  At  least  six  eggs  and  one  quart  of  milk 
a  day  should  be  taken  in  addition  to  the  regular  meals.  Daily 
cold  sponge  baths  of  the  chest.  Moderate  exercise  is  beneficial, 
but  should  not  be  carried  to  the  point  of  causing  a  rise  in 
temperature.  Hemorrhages  are  seldom  fatal.  The  best 
routine  treatment  is  absolute  rest ;  ice  to  suck,  and  an  ice-bag 
on  the  affected  side.  When  cough  is  severe  enough  to  pro- 
duce vomiting,  or  to  disturb  the  sleep,  inhalations  of  steam. 
Rest  in  bed  when  fever  is  high;  if  it  is  over  103°.  cold  spong- 
ing. Careful  selection  of  the  diet  and  regulation  of  the  bowels. 
Enemata  for  digestive  disturbances.  A  careful  spinal  analysis 
should'  be  made  in  every  case  on  account  of  the  existence  of 
complications  in  different  organs.  The  3rd  thoracic  vertebra 
is  adjusted  for  the  apex  of  the  lungs;  the  7th  cervical  vertebra, 
and  the  1st  and  2nd  thoracic  vertebrae  are  adjusted  for  the 
catarrh  of  the  bronchial  tubes ;  for  the  lower  portion  of  the 
lungs  adjustments  are  made  as  far  down  as  the  5th  thoracic 
vertebra.  Since  involvement  of  the  liver,  kidneys,  spleen, 
and  gastro-intestinal  system  is  frequent  in  this  disease,  at- 
tention should  be  paid  to  the  spinal  segments  which  control 
these  parts  of  the  body,  and  adjustments  made  wherever  in- 
dicated. Rectal  dilatation,  having  decided  eft'ects  upon  the 
nervous  system,  through  stimulation  of  the  ganglion  impar 
and  upon  the  circulation  in  general,  is  a  very  good  measure 
in  the  treatment  of  all  varieties  of  tuberculosis.  It  is  claimed 
that  rectal  dilatation  will  produce  a  cure  in  a  majority  of 
cases  of  early  tuberculosis.  Some  authors  claim  that  the  per- 
sistent use  of  the  sponge  bath  for  two  or  three  days,  giving 
as  high  as  20  baths  a  day,  will  often   do  away  with   grave 


INFECTIOUS  DISEASES  407 

symptoms.  Others  advise  a  fast  in  the  treatment  of  tuber- 
culosis, claiming  that  a  fast  of  two  or  three  weeks  enables  the 
system  to  eliminate  all  toxic  materials,  and  permit  the  nervous 
system  to  produce  that  measure  of  resistance  necessary  to  an 
eradication  of  the  disease,  but  the  author  does  not  share  this 
opinion,  holding  that  any  gain  in  weight  is  always  a  favor- 
able sign  in  tuberculosis. 

Tuberculosis  of  the  Larynx 

Etiology. — This  condition  is  secondary  to  tuberculosis  of 
the  lungs,  and  is  due  to  the  production  of  reflex  subluxations 
in  the  segments  which  govern  the  larynx. 

Pathology. — Tubercles  which  undergo  caseation  and  ulcer- 
ation first  appear  on  the  mucous  membrane,  and  then  involve 
the  cartilage.  The  ulcers  are  saucer-like,  have  irregular  bor- 
ders, and  their  base  is  gray.  The  process  invades  the  sur- 
rounding tissues. 

Symptoms. — The  first  sign  is  slight  hoarseness.  Finally 
all  the  symptoms  of  chronic  laryngitis  are  present.  Later 
on  dysphagia  develops. 

Treatment. — Adjust  the  4th  cervical  and  the  2nd  and  5th 
thoracic  vertebrae.  Give  general  treatment  as  indicated  above 
under  the  heading  of  "The  Treatment  of  Tuberculosis." 

Tuberculosis  of  the  Alimentary  Tract 

Tuberculosis  of  the  lip  is  rare  and  simulates  cancer. 
Tuberculosis  of  the  tongue  shows  as  ragged-edged  tubercular 
ulcers.  Tuberculosis  of  the  tonsils  appears  as  small  tuber- 
cular ulcers.  It  is  claimed  that  the  tonsil  is  the  usual  point 
at  wdiich  the  bacilli  enter  the  body.  Tuberculosis  of  the 
stomach  is  rare.  Primary  tuberculosis  of  the  intestines  afifects 
children,  and  the  most  common  symptoms  are  distension  of 
the  abdomen,  tenderness,  fever,  diarrhea,  and  emaciation.  The 
ulcers  may  heal,  and  stricture  of  the  bowel  follow.  In  the 
secondary  form,  perforation  and  hemorrhage  may  occur. 

Treatment. — Adjust  according  to  the  region  affected,  and 
give  general  treatment  as  mentioned  under  tuberculosis. 

Tuberculosis  of  the  Genito-Urinary  Tract 
Tuberculosis  of  the  Kidney.-— The  pelvis  of  the  kidney  and 
the  ureters  are  involved.     The  kidney  may  'present  all  stages 


_;08  SPINAL  ADJUSTMENT 

from  miliary  tubercles  to  complete  destruction  of  the  organ. 
Both  kidneys  are  usually  affected.  The  symptoms  are  fre- 
quent urination,  the  urine  containing  pus  and  blood.  Tender- 
ness in  the  lumbar  region.  Irregular  fever.  Loss  of  weight 
and  strength.  The  treatment  includes  adjustment  of  the  10th 
thoracic  vertebra  and  any  other  subluxations  which  may  be 
found. 

Tuberculosis  of  the  Ureter  and  Bladder. — This  usually 
follows  tuberculosis  of  the  kidney  and  the  symptoms  are 
those  of  an  obstinate  case  of  cystitis.  Treatment  embraces 
adjustment  of  the  10th  thoracic  and  the  1st  lumbar  vertebrae. 
Give  spinal  concussion  over  the  spinous  processes  of  the  4th 
and  .Sth  lumbar  vertebrae. 

Tuberculosis  of  the  Prostate  and  Seminal  Vesicles  is  evi- 
denced by  a  rectal  examination,  which  detects  hard  nodules, 
about  one-half  inch  in  diameter.  Treatment  consists  of  ad- 
justment of  the  Sth  lumbar  vertebra.  Use  concussion  over 
the  12th  thoracic  vertebra.     Rectal  dilatation  is  also  useful. 

Tuberculosis  of  the  Testes  is  characterized  by  pain,  nodules 
which  may  be  palpated,  and  softening  of  portions  of  the  testes. 
Adjust  the  Sth  lumbar  vertebra.  Surgical  interference  is 
sometimes  necessary. 

Tuberculosis  of  the  Fallopian  Tubes  is  not  uncommon, 
but  the  uterus  arrd  ovaries  are  very  rarely  afifected.  The 
symptoms  are  those  of  chronic  salpingitis. 

Treatment. — Adjust  the  4th  lumbar  vertebra. 

Relapsing  Fever   (Famine  Fever,  Seven-Day  Fever) 

Etiology. — The  exciting  cause  is  the  spirillum  of  Ober- 
meier.  The  primary  cause  is  a  low  grade  of  vital  resistance 
due  to  faulty  innervation. 

Pathology. — No  characteristic  lesions  are  present.  The 
spleen  is  enlarged  and  softened.  The  liver  and  kidneys  are 
congested.  Catarrhal  inflammation  of  the  stomach  and  bile- 
ducts  may  exist. 

Symptoms. — There  is  an  incubation  period  of  from  5  to  7 
days.  This  is  followed  by  a  febrile  paroxysm  lasting  about 
six  days ;  the  onset  is  sudden  with  pains  in  the  back  and 
limbs,  a  severe  chill,  and  rise  in  temperature  to  104°.  An 
intermission,    lasting    six    days,    follows,    during    which    the 


INFECTIOUS  DISEASES  -  409 

patient  is  in  fair  health.  A  relapse  then  occurs,  lasting  six 
days.  Several  such  intervals  and  relapses  may  occur.  Palpa- 
tion of  the  vertebral  column  detects  one  or  two  segments 
which  are  the  seat  of  a  higher  temperature  than  others.  That 
segment  in  which  the  temperature  is  the  highest  is  usually 
about  the  6th  and  10th  thoracic  vertebrae. 

Treatment. — Adjust  the  6th,  8th  and  10th  thoracic  ver- 
tebrae. The  patient  should  be  isolated.  Careful  disinfection 
is  necessary  to  prevent  the  spread  of  the  disease.  Rest  in 
bed  and  proper  diet. 

Malaria   (Ague;   Chills  and   Fever) 

Etiology. — This  disease  is  seen  mostly  in  tropical  and 
temperate  climates,  and  in  lowlands,  swamps,  and  the  sea- 
coast.  The  attacks  are  most  common  in  the  autumn.  The  ex- 
citing cause  is  the  plasmodium  malariae,  a  parasite  developing 
in  a  mosquito,  and  which  is  transmitted  to  man,  by  the  bite 
of  the  infected  mosquitos.  The  parasites  are  of  several 
varieties,  and  each  causes  a  certain  type  of  the  disease. 

Pathology. — In  acute  cases  the  red  corpuscles  and  hemo- 
globin are  diminished.  The  spleen  is  enlarged,  soft,  and  con- 
gested. In  pernicious  types  with  cerebral  symptoms  the 
brain  is  often  congested.  Anemia  is  present  in  severe  cases. 
In  chronic  cases  the  spleen  is  much  enlarged,  infiltrated  with 
connective  tissue,  gray,  and  pigmented ;  its  capsule  is  thick- 
ened. The  liver  is  similarly  affected.  The  kidneys  are  the 
seat  of  inflammatory  changes.  ]\Ialaria  exists  in  three  forms : 
(1)  Intermittent  fever;  (2)  Remittent  fever;  (3)  Pernicious 
malaria. 

Intermittent  Fever 

This  form  of  malaria  is  characterized  by  a  chill,  a  hot  and 
a  sweating  stage.  The  chill  begins  with  malaise,  headache, 
and  nausea,  followed  by  the  chill  itself,  the  skin  becoming 
cold  and  pale.  The  temperature  rises  to  103°  or  104°.  This 
stage  lasts  from  a  half  to  one  hour.  It  is  followed  by  the  hot 
stage  in  which  the  temperature'  goes  to  106°  or  higher.  The 
pulse  is  tense  and  rapid.  The  skin  is  hot  and  red.  Headache, 
backache,  and  thirst  are  also  present.  The  urine  is  scanty, 
high-colored,  and  of  high  specific  gravity.  This  stage  lasts 
from  one  to  ten  hours,  and  is  followed  gradually  by  the  sweat- 


410  SPINAL  ADJUSTMENT 

ting  stage  which  commences  on  the  forehead,  and  extends 
over  the  entire  body.  As  sweating  becomes  profuse,  the  symp- 
toms subside.  This  stage  lasts  about  3  hours.  An  intermis- 
sion, varying  in  length  according  to  the  nature  of  the  malarial 
organism,  is  followed  in  turn  by  another  paroxysm. 

Remittent   Fever    (Bilious   Fever) 

In  this  type  of  malaria  the  temperature  is  continuously 
above  normal,  with  slight  remissions  at  definite  intervals. 
There  are  the  same  stages  as  in  the  preceding  form,  but  the 
cold  stage  is  not  so  marked,  and  is  sometimes  entirely  want- 
ing. The  temperature  is  very  high  during  the  hot  stage,  and 
severe  headache  and  gastric  disturbances  are  present.  The 
sweating  stage  is  not  well-marked,  and  in  many  cases  entirely 
absent.  Jaundice,  and  enlargement  of  the  liver  and  spleen 
occur. 

Pernicious  Malarial  Fever  (The  Congestive  Chill) 

This  type  of  malaria  exists  in  three  forms,  namely,  the 
algid  or  asthenic,  the  hemorrhagic,  and  the  comatose.  The 
algid  variety  commences  with  great  prostration  and  persistent 
vomiting.  Diarrhea  and  anuria  then  develop.  The  tem- 
perature may  be  subnormal.  In  the  hemorrhagic  form  the 
characteristic  sign  is  hemoglobinuria  which  is  probably  due 
to  the  previous  use  of  quinine.  In  the  comatose  variety,  a 
high  temperature  followed  by  delirium  or  coma  are  the  char- 
acteristic symptoms. 

Treatment  of  Malaria 

Adjust  the  6th,  8th  and  10th  dorsal,  and  the  5th  cervical 
vertebrae.  Concussion  of  the  upper  three  lumbar  vertebrae  is 
Ijeneficial,  since  it  produces  contraction  of  the  spleen.  Enemas 
should  be  given.    A  lic|uid  diet  is  necessary  during  the  disease. 

Diphtheria 

Etiology. — Irritation  of  the  nerves  supplying  the  air  pas- 
sages with  a  resulting  weakening  of  the  nerve-supply  to  the 
air  passages,  is  the  chief  predisposing  cause,  as  is  shown  by 
the  fact  that  adjustment  assists  in  stopping  the  progress  of 
the  disease.  Diphtheria  is  endemic  in  cities  and  epidemic  in 
the   cold   autumn   months,   the   severity   varying  in   different 


INFECTIOUS  DISEASES  411 

epidemics.  Children  from  two  to  fifteen  years  of  age  are 
most  susceptible.  The  exciting  cause  is  the  Klebs-Loeftler 
bacillus. 

Pathology. — The  affected  area  shows  a  grayish,  false  mem- 
brane, made  up  of  a  fibrinous  exudate,  and  necrotic  tissue. 

Symptoms. — The  incubation  period  varies  from  two  to 
seven  days.  The  invasion  may  be  severe  or  mild.  It  is 
usually  marked  by  chilliness,  sometimes  convulsions,  pain  in 
the  back  and  limbs,  and  a  temperature  of  102°  to  104°  F. 

NASAL  DIPHTHERIA.— The  nasal  cavities  are  ob- 
structed by  a  gray,  false  membrane.  The  fever  may  not' be 
high,  but  there  are  great  systemic  disturbances.  The  cervical 
and  submaxillary  lymph  nodes  are  enlarged,  early  in  the 
course  of  the  disease. 

PHARYNGEAL  DIPHTHERIA.— Dysphagia ;  fever 
100°- 102°.  Considerable  systemic  disturbance  is  early.  The 
cervical  lymph  nodes  may  be  enlarged.  A  false  membrane, 
commonly  situated  on  the  tonsils,  is  present.  When  part  of 
this  rnembrane  is  removed,  a  bleeding  surface  is  left.  Late 
symptoms  may  be  intense  toxaemia,  cardiac  failure,  and  the 
typhoid  state. 

LARYNGEAL  DIPHTHERIA.— Often  the  onset  is 
gradual  and  there  may  be  no  membrane  in  the  throat,  and  the 
operator  is  called  in  to  see  the  case  because  the  child,  which 
has  been  sick  with  a  "cold"  for  a  few  days,  has  developed  a 
croupy  cough  and  shortness  of  breath.  The  dyspnea,  the 
aphonia  or  hoarseness  and  the  croupy  cough  usually  are  con- 
tinuous and  progressive.  The  fever  is  moderate.  The  sys- 
temic disturbances  soon  become  pronounced.  The  cervical 
lymph  nodes  are  swollen.  Symptoms  of  asphyxiation  may 
develop. 

Treatment. — If  diphtheria  is  taken  sufficiently  early,  and 
the  proper  adjustments  are  made,  there  will  be  no  difficulty  in 
checking  the  progress  of  the  disease.  Adjust  the  middle  cer- 
vical vertebrae,  and  the  5th  thoracic.  Rectal  dilatation  is  indi- 
cated in  diphtheria.  Swabbing  of  the  throat  with  an  antiseptic 
is  very  necessary.  Give  the  patient  large  amounts  of  hot 
water  to  drink,  but  no  food  of  any  kind.  For  nasal  cases,  irri- 
gation of  nose  and  throat  with  salt  solution.     For  laryngeal 


412  SPINAL  ADJUSTMENT 

cases,  cold  or  hot  applications  to  the  neck  and  steam  inhala- 
tions. For  paralysis,  rest,  electricity,  massage,  etc.  For 
cardiac  weakness,  rest,  and  avoidance  of  all  exertion. 

Pellagra 

Etiology. — The  primary  cause  is  faulty  innervation,  result- 
ing in  a  low  grade  of  vital  resistance.  The  exciting  cause  is 
supposed  to  be  maize ;  and  "The  morbific  action  of  maize 
has  been  variously  attributed  to  (a)  Deficiency  in  its  nutritive 
principles,  (b)  Specific  toxic  substance  contained  normally 
in  the  grain,  (c)  Poisons  elaborated  after  it  has  been  in- 
gested, (d)  Toxic  substances  elaborated  during  decomposi- 
tion of  the  grain,  (e)  Fungi  or  bacteria  found  on  maize." 
(Manson.) 

Symptoms. — The  prodromal  period  is  characterized  by 
malaise.  The  common  symptoms  following  the  onset  of  the 
disease  are  pain  and  tenderness  in  the  epigastric  region,  con- 
stipation alternating  with  bloody  diarrhea,  pain  in  the  back 
and  extremities,  and  headache  and  vertigo.  A  fine  rash  covers 
the  body  and  lasts  for  2  or  3  weeks.  Reflexes  are  exaggerated, 
insomnia  and  tremors  of  the  tongue  are  present. 

Treatment. — Adjust  the  6th  and  10th  thoracic  vertebrae. 
Hot  baths  should  be  given  about  twice  daily,  to  promote 
thorough  elimination  through  the  skin.  The  diet  should  be 
carefully  regulated,  fruits  and  vegetables  being  eaten  ex- 
clusively. 


CHAPTER  III 

Diseases  Caused  by  Animal  Parasites 
Ascariasis 

1.  Round  Worm  (Ascaris  Lumbricoides)  is  similar  to  tlie 
angle  worm  in  shape,  and  of  a  light  brown  color.  The  eggs 
are  small,  oval,  and  brownish-red.  Generally  only  one  or  two 
worms  are  present  in  a  patient,  but  sometimes  many  are 
present.  The  upper  part  of  the  small  intestine  is  where  they 
are  generally  found,  but  they  may  enter  any  part  of  the 
gastro-intestinal  or  respiratory  tract  or  the  bile-ducts  and 
liver.  They  are  most  common  in  children,  and  picking  of  the 
nose,  grinding  of  the  teeth,  restlessness,  or  even  convulsions 
are  the  usual  symptoms  However,  no  signs  except  their 
presence  in  the  stools  may  be  noted. 

2.  Pin  Worm  (Oxyuris  Vermicularis)  is  a  worm  of  small 
size  commonly  seen  in  children.  Its  habitat  is  the  lower 
bowel.  The  characteristic  symptoms  are  violent  itching  about 
the  anus,  and  the  presence  of  the  worms  in  the  stools. 

Treatment. — Adjust  the  11th  and  12th  dorsal  and  1st  and 
2nd  lumbar  vertebrae.  Wash  out  the  lower  bowel  every  day 
with  a  solution  of  vinegar  or  salt. 

Anchylostomiasis    (Brickmaker's    Anemia;    Miner's    Cachexia) 

Etiology. — Caused  by  the  anchylostorum  duodenale,  a 
small  worm  which  is  present  in  the  small  intestine,  attaching 
itself  to  the  mucous  membrane  by  its  hooks,  and  which  lives 
by  sucking  blood.  The  characteristic  symptom  is  the  presence 
of  the  eggs  in  the  stools. 

Treatment. — The  stools  should  be  disposed  of  and  drink- 
ing water  boiled.  Adjust  the  11th  and  12th  dorsal  and  1st 
and  2nd  lumbar  vertebrae.     Liquid  diet. 

Echinococcus  Disease  (Hydatid  Disease) 

Etiology. — The  echinococci  are  the  larvae  or  embryos  of 
the  taenia  echinococcus  from  the  dog. 

413 


414  SPINAL  ADJUSTMENT 

Pathology. — The  echinococcus  cyst  may  be  found  in  the 
liver,  lung,  spleen,  kidney  and  other  organs.  The  embryo 
originally  has  six  hooks.  When  the  cyst  begins  to  form,  the 
booklets  disappear.  The  cyst  fills  with  clear  fluid.  From  the 
inner  of  the  two  layers  of  the  parent  cyst,  multiple  daughter 
cysts  form.  These  become  free  from  the  mother  cyst,  and 
from  the  inner  layer  of  the  daughter  cysts,  buds  may  form 
granddaughter  cysts.  Within  the  cysts  scolices  are  formed 
which  are  the  heads  of  new  taeniae  and  are  made  up  of  four 
sucking  discs  and  four  booklets.  In  time  the  cyst  may  un- 
dergo inspissation,  suppuration,  or  rupture.  Rarely  in  the 
liver,  the  cyst  is  multilocular  and  the  fluid  gelatinous, — the 
Multilocular  Echinococcus. 

Symptoms. — In  the  liver. — The  symptoms  are  those  of 
tumor ;  increase  of  liver  dulness ;  rarely  fluctuation ;  a  soft 
elastic  tumor;  and  mild  or  no  subjective  symptoms.  In  the 
Respiratory  System. — In  the  pleura,  the  signs  are  those  of 
pleurisy  with  effusion.  In  the  lung,  it  generally  results  in 
abscess  or  gangrene,  and  the  diagnosis  is  made  by  finding  the 
booklets  in  the  sputum.  In  the  Kidney. — May  be  latent  or 
resemble  a  hydronephrosis.  In  the  Nervous  System. — 
Usually  located  in  the  cerebrum  and  resembles  brain  tumor. 

Treatment. — Give  adjustments  according  to  the  location 
of  the  disease.     Surgical  measures  are  sometimes  necessary. 

Filariasis 

Definition. — The  most  common  species  is  the  Filaria  of 
Bancroft.  The  eggs  are  present  in  the  blood  stream  while 
the  adult  worms  are  found  in  the  lymphatics. 

Symptoms. — "Filariae  may  cause  no  symptoms.  If  the 
adult  worms  or  ova  block  lymph  channels  they  cause  hema- 
tochyluria,  lymph  scrotum,  elephantiasis,  etc.  (1)  HEMA- 
TOCHYLURIA:  The  only  symptom  is  the  passage  at  in- 
tervals of  milky,  bloody,  or  chylous  urine,  which  deposits  a 
reddish  sediment.  It  contains  minute  fat  drops,  usually  red 
cells,  and  sometimes  the  embryos.  The  passage  of  blood  clots 
from  the  bladder  may  cause  pain.  (2)  LYMPH  SCROTUM : 
The  scrotal  tissue  is  much  thickened,  and  enlarged  lymphatics 
are  seen."  (Dayton.) 

Treatment. — Boil    the    drinking   water.      A   careful    spinal 


DISEASES  CAUSED  P-Y  AXIMAL  PARASITES  415 

analysis  should  be  made  and  adjustments  made  accordingly. 
The  prognosis  is  however  unfavorable. 

Tapeworms 

The  pork  tapeworm  is  six  to  twelve  feet  long.  It  has  a 
round  head  smaller  than  that  of  a  pin,  with  a  projection,  on 
which  is  placed  a  double  ring  of  small  hooks  and  below  which 
are  four  sucking  disks.  By  means  of  these  hooks  and  disks 
the  worm  attaches  itself  to  the  lining  of  the  small  intestine  of 
man.  Below  the  head  is  the  neck,  which  is  succeeded  by  a 
large  number  of  segments,  increasing  in  size  from  the  neck 
down.  Each  segment  contains  the  generative  organs  of  both 
sexes.  The  parasite  is  fully  developed  in  three  months.  Seg- 
ments then  continually  break  oiT  and  are  discharged  at  stool. 
When  swallowed  by  a  pig  or  man  the  shells  containing  the 
embryo  worms  are  digested  and  the  embryos  wander  to 
various  parts  of  the  body,  where  they  change  to  "measles." 
Each  of  these  contains  a  tapeworm  head.  When  n'leat  con- 
taining "measles"  and  which  is  only  partly  cooked  is  eaten, 
the  cyst  is  dissolved  in  the  human  stomach  and  the  freed  head 
attaches  itself  to  the  lining  of  the  intestine,  and  develops  into 
a  tapeworm.  The  beef  tapeworm,  is  the  common  form  in  this 
country.  It  is  larger  than  the  preceding,  being  fifteen  to 
twenty  feet  long,  has  larger  segments  than  the  pork  tape- 
worm, and  a  large  head,  which  possesses  no  booklets,  but  is 
square  and  has  four  sucking  disks. 

Symptoms. — These  are  often  absent.  In  some  cases, 
colicky  pains,  excessive  appetite,  indigestion,  emaciation,  con- 
stipation, palpitation  of  the  heart,  faintness,  spasms,  anemia 
and  itching  of  the  nose  and  anal  region  are  present.  The 
ingestion  of  a  large  meal  often  removes  most  of  these  symp- 
toms. The  finding  of  one  or  more  segments  of  the  tapeworm 
in  the  stools  is  diagnostic. 

Treatment. — Some  Chiropractors  claim  to  be  able  to  cause 
the  removal  of  tapeworms  by  spinal  adjustment.  They  base 
this  view  on  the  opinion  that  tapeworms  as  well  as  other 
animal  parasites  are  simply  scavengers  in  the  gastro-intes- 
tinal  tract.  This  view  is,  however,  incorrect,  since  the  pres- 
ence of  tapeworm  in  the  intestine  is  due  solely  to  the  fact 
that   the   patient   has    eaten    meat   which    contains   the    eggs. 


416  SPINAL  ADJUSTMENT 

Under  normal  conditions  a  sufficient  degree  of  acidity  is 
probably  present  to  destroy  these  eggs,  and  if  the  gastro- 
intestinal tract  is  in  such  a  normal  condition,  these  eggs  may 
be  ingested,  and  destroyed.  However,  there  is  not  enough 
acid  in  the  stomach  to  destroy  a  tapeworm.  In  the  author's 
opinion,  fasting  and  giving  a  vermifuge,  or  the  eating  of 
pumpkin  seeds,  are  the  only  logical  methods  of  treating  this 
condition.  Adjustment  of  the  5th  and  8th  thoracic  vertebrae 
may  be  given  for  their  influence  on  the  secretion  of  the  di- 
gestive fluids.  The  10th  and  12th  thoracic,  and  the  second 
lumbar  vertebrae  may  also  be  adjusted  for  their  influence  on 
the  large  intestine. 

Trichinosis 

Etiology. — The  trichina  spiralis,  which  lives  in  the  small 
intestine,  and  the  embryos  of  which  migrate  to  the  muscles. 

Symptoms. — A  week  or  two  after  eating  the  measled  pork, 
the  symptoms  begin  with  a  chill  and  high  fever,  severe  pains 
and  stiffness  in  the  muscles,  gastro-intestinal  disturbances, 
edema,  and  rapid  loss  of  flesh  and  strength.  The  stools 
should  be  examined. 

Treatment. — Adjust  the  lower  dorsal  and  upper  lumbar 
vertebrae.  Enemas,  especially  in  the  early  stages,  when  the 
parasites  are  present  in  the  stools.  Symptomatic  therapy. 
Hot  compresses  over  the  painful  muscles. 


CHAPTER  IV. 

The  Intoxications  and  Sunstroke 
Alcoholism 

Etiology. — Acute  Alcoholism,  as  its  name  implies,  is  due 
to  the  consumption  of  a  large  amount  of  alcohol,  during  a 
brief  period.  Chronic  Alcoholism  is  due  to  the  continuous 
excessive  use  of  alcohol. 

The  following  symptoms  are  characteristic  of  this  state : 
Full  pulse ;  flushed  face.  The  mental  faculties  are  first  stimu- 
lated, then  blunted.  There  is  loss  of  co-ordination  shown  by 
unsteady  gait,  then  relaxation  of  the  muscles,  and  finally  un- 
consciousness and  puffy  breathing.  Pupils  are  contracted  or 
dilated,  and  if  the  face  is  struck,  dilatation  is  produced. 
Temperature  is  subnormal,  reflexes  and  sensation  are  de- 
creased. 

The  common  symptoms  of  chronic  alcoholism  are  tremor 
of  the  hands,  chronic  gastritis,  atrophic  cirrhosis  of  the  liver, 
hardening  of  the  arteries,  neuritis  and  fatty  degeneration  of 
the  heart. 

The  symptoms  of  delirium  tremens  are  first  insomnia, 
restlessness  and  depression.  Delirium  accompanied  by  loud 
talking,  and  hallucinations  then  develop  and  the  patient 
imagines  he  sees  various  things  and  hears  different  sounds, 
and  becomes  very  violent.  There  is  marked  insomnia.  The 
tongue  is  heavily  coated.  This  condition  continues  for  several 
days,  at  the  end  of  which  time  restoration  of  mental  and 
physical  faculties  takes  place. 

Treatment. — Acute  alcoholism :  Gastric  lavage,  and  a  cold 
bath.  Chronic  alcoholism :  Confinement  in  a  sanitarium, 
warm  magnesium  sulphate  baths  for  restlessness  and  sleep- 
lessness. Complete  withdrawal  of  alcohol,  and  nourishing 
diet.  Delirium  tremens :  Do  not  forcibly  restrain  the  patient, 
but  confine  him,  and  constantly  watch  him  to  prevent  self- 
injury.     Alcohol   should   be   entirely   withdrawn.     A   general 

417 


418  SPINAL  ADJUSTMENT 

adjustment  is  indicated;  pay  especial  attention,  however,  to 
the  5th  and  7th  thoracic  vertebrae. 


Morphine   Habit 

Etiology. — The  morphine  habit  is  usually  acquired  by  re- 
peated use  of  the  drug  for  pain. 

Symptoms. — These  include  constipation,  a  yellowish  com- 
plexion, tremors,  insomnia,  and  mental  unrest  and  impair- 
ment. When  the  drug  is  withheld  from  the  patient,  he  suffers 
extremely;  a  general  feeling  of  unrest,  anorexia,  nausea, 
diarrhea,  neuralgic  pains,  and  ringing  of  the  ears  are  the  chief 
symptoms  present. 

Treatment. — If  the  case  has  not  progressed  too  far,  general 
adjustment,  a  wholesome  environment,  and  a  thorough 
eliminative  treatment,  followed  by  a  balanced  diet,  will  pro- 
duce satisfactory  results.  The  fact,  however,  must  not  be 
lost  sight  of,  that  some  underlying  ailment  very  likely  induced 
morphinism  in  the  first  place.  See  to  it  that  such  conditions 
are  removed.  Adjust  the  atlas  and  the  5th  thoracic  vertebrae. 
Hot  magnesium  sulphate  baths  are  very  useful  in  this  disease, 
by  reason  of  their  eliminative  effect,  which  relieves  the  pain 
and  restlessness.  It  will  often  be  found  in  treating  a  case  of 
this  nature,  that  after  the  patient  has  been  in  this  bath  for  a 
half  hour,  he  becomes  much  quieted  and  will  sleep  for  two  or 
three  hours.  The  pain  then  returns,  and  the  bath  should  be 
repeated.  This  should  be  done  for  two  or  three  days,  at  the 
end  of  which  time  it  will  be  found  that  the  patient's  condition 
is  much  improved,  if  not  entirely  relieved. 

Cocaine  Habit 

Symptoms. — The  drug  is  taken  as  snufif,  in  sprays,  or 
hypodermically.  Large  doses  cause  great  mental  excitement, 
and  occasionally  convulsions.  This  is  followed  by  cardiac 
and  respiratory  weakness,  prostration  and  coma.  The  cocaine 
habit  causes  digestive  disorders,  loss  of  flesh  and  strength, 
disordered  heart  action,  mental  impairment,  nervousness,  and 
moral  depravity. 

Treatment. — Same  as  for  morphine  habit. 


INTOXICATIONS  AND  SUNSTROKE  419 

Chloral  Habit 

•  Symptoms. — There  is  Hrst  exhilaration,  which  is  followed 
I)y  mental  and  physical  depression,  foul  breath,  spongy  gums, 
anorexia,  indigestion,  emaciation,  permanent  dilatation  of 
cutaneous  blood  vessels,  intermittent  pulse,  irritability,  in- 
somnia, sensory  and  motor  disturbances,  and  impairment  of 
mentality. 

Treatment. — Same  as  for  morphine  habit. 

Lead   Poisoning 

Etiology. — Those  engaged  in  occupations  which  involve 
the  handling  of  lead,  such  as  painters,  plumbers,  and  printers, 
are  very  liable  to  contract  lead  poisoning. 

Symptoms. — The  characteristic  symptoms  and  signs  are 
lead  colic,  retracted  abdomen,  constipation,  a  blue  line  on  the 
gums,  wrist  drop,  headache,  tremors,  anemia,  pains  in  the 
joints.  Common  sequels  are  wrist  drop,  arteriosclerosis, 
nephritis,  and  optic  atrophy. 

Treatment. — Remove  the  cause.  Hot  baths  for  their 
eliminative  effects.  Adjust  the  5th  and  10th  dorsal  and  3rd 
lumbar  vertebrae. 

Arsenic  Poisoning 

Etiology. — Arsenical  poisoning  can  be  contracted  from 
arsenical  paint,  wall  paper,  and  any  material  containing 
arsenic  with  which  persons  are  brought  into  close  daily  con- 
tact. 

Pathology. — Gastro-enteritis,  fatty  degeneration  of  liver, 
spleen,  and  kidneys,  peripheral  neuritis.  Arsenic  is  present 
in  tissues. 

Symptoms. — The  characteristic  signs  and  symptoms  of 
this  form  of  intoxication  are  edema  of  the  eyelids,  dryness  of 
the  throat,  gastro-intestinal  disturbances,  eruptions  and  pig- 
mentation of  the  skin.  Paralysis  of  extremities,  especially  the 
legs,  with  atrophy  and  numbness,  but  little  pain. 

Treatment. — Remove  the  cause.  Massage  and  galvanism 
for  paralysis.  Otherwise  treatment  is  the  same  as  for  lead 
poisoning,  except  that  spinal  adjustment  will  be  most  neces- 
sary in  the  5th  and  7th  thoracic  segments. 


420  SPINAL  ADJUSTMENT 

Food  Poisons 

Etiology. — This  includes  poisoning  b_y  spoiled  meats,  fish 
and  oysters,  candies,  soups,  canned  foods,  cheese  and  ice 
cream. 

Symptoms. — Acute  gastro-enteritis,  with  intense  prostra- 
tion terminating  in  collapse. 

Treatment. — Empty  the  stomach  by  giving  a  solution  of 
soda  in  tepid  water  to  induce  vomiting.  Give  a  high  enema. 
Stimulants  may  be  necessary.  Adjust  the  5th,  6th  and  7th 
and  lower  dorsal  vertebrae,  and  the  1st  and  2nd  lumbar  ver- 
tebrae. 

Sunstroke 

Symptoms. — In  severe  cases,  where  exposed  to  intense 
heat,  the  patient  falls  unconscious,  and  death  occurs  almost 
immediately  or  after  a  few  hours,  from  coma,  and  failure  of 
the  heart  and  respiration.  In  the  usual  cases  there  is  sudden 
arrest  of  perspiration,  headache,  vertigo,  nausea  and  vomiting; 
failing  vision,  then  unconsciousness,  which  may  be  temporary 
or  pass  into  coma.  The  face  is  flushed,  skin  dry  and  hot, 
pupils  dilated  for  a  time,  then  usually  greatly  contracted ; 
muscular  relaxation  or  spasms;  fever  is  107°  to  110°  or  even 
higher;  pulse  high  tension  and  rapid;  respirations  deep  and 
labored  or  snoring.  In  fatal  cases,  coma  deepens,  the  pulse 
becomes  weak  and  rapid,  respiration  irregular,  shallow,  and 
rapid,  or  of  Cheyne-Stokes  type,  and  death  occurs  in  twenty- 
four  to  thirty-six  hours.  In  others,  consciousness  returns, 
temperature  falls,  pulse  and  respiration  become  normal,  and 
recovery  with  sequelae  occurs.  Prominent  among  the  sequels 
are  physical  weakness,  impaired  memory  or  power  of  con- 
centration, or  headache  and  mental  disturbance  whenever  the 
weather  is  warm. 

Treatment. — Adjust  the  1st  and  4th  cervical  and  the  10th 
dorsal  vertebrae.  For  mild  cases  rest  in  a  cool  place,  cold 
sponging,  and  stimulants.  For  severe  cases  immediate  bath- 
ing in  ice  water,  with  friction,  and  ice  water  enemas.  If  ice 
cannot  be  obtained,  strip  and  sprinkle  with  water  until  tem- 
perature is  reduced.  Gastric  lavage,  especially  if  alcoholic. 
Subsequently  cold  sponging  if  needed. 


CHAPTER  V 

Constitutional  Diseases 
Chronic  Articular  Rheumatism 

Etiology. — The  cause  of  this  disease  is  faulty  innervation 
of  the  joints,  as  a  result  of  reflex  subluxations  produced  dur- 
ing the  course  of  acute  rheumatism  and  superinduced  by 
exposure  to  cold  and  wet. 

Pathology, — The  capsule  of  the  joint,  together  with  its 
ligaments  and  surrounding  tissue  is  thickened. 

Symptoms. — The  affected  joints  are  stifif  and  painful  dur- 
ing damp  weather.  The  movement  of  the  afifected  joints  be- 
comes more  and  more  impaired,  and  the  joints  distorted,  as 
the  disease  continues.  No  severe  constitutional  disturbances 
are  present  in  uncomplicated  cases.  Usually  a  number  of 
joints  are  affected. 

Treatment. — Make  adjustments  in  those  segments  which 
control  the  parts  affected;  also  adjust  the  6th  and  10th  thor- 
acic vertebrae.  Massage  and  passive  movements  are  useful 
for  overcoming  stiffness  of  the  joints.  Baking  of  the  joints 
or  application  of  heat  in  various  ways :  hot  air,  electricity, 
or  steam  baths  are  very  useful.  The  diet  should  be  free  from 
meat,   and  only  fresh   vegetables   should  be   used. 

Muscular  Rheumatism 

Etiology. — This  condition  is  caused  by  faulty  innervation 
which  is  produced  through  a  draught  of  cold  air  striking  a 
part  of  the  body  the  afferent  impulses  from  which  reflexly 
produce  vertebral  subluxations. 

Symptoms. — An  acute  attack  usually  occurs,  and  is  marked 
by  a  sudden  onset,  and  pain,  soreness  and  rigidity  of  the 
affected  muscles,  increased  by  motion.  There  is  no  rise  in 
temperature.  The  duration  is  about  one  week,  and  develops 
frequently  into  the  chronic  form,  which  is  marked  by  acute 
exacerbations  during  changes  in  the  weather. 

The  disease  may  affect  all  or  some  of  the  voluntary  mus- 

421 


422  SPINAL  ADJUSTMENT 

cles,  but  its  most  frequent  and  important  varieties  are:  "1. 
CEPHALODYNIA— Situated  in  the  occipito-frontalis  mus- 
cle. It  is  distinguished  from  neuralgia  of  the  trifacial  or 
occipital  nerve,  by  pain  on  both  sides  of  the  head,  excited 
or  aggravated  by  the  movements  of  the  muscles  and  by 
absence  of  disseminated  points  of  tenderness.  The  muscles 
of  the  eye  may  be  affected,  and  movements  of  that  organ  excite 
pain.  If  the  temporal  and  masseter  muscles  are  attacked, 
mastication  induces  pain.  2.  TORTICOLLIS — Wry  neck, 
or  stiff  neck.  Situated  in  the  sternomastoid  muscles.  Gener- 
ally limited  to  one  side  of  the  neck,  toward  which  side  the 
head  is  twisted,  great  pain  being  excited  on  attempting  to 
turn  to  the  opposite  side.  Rheumatism  of  the  muscles  of  the 
back  of  the  neck,  cervicodynia,  may  be  mistaken  for  occipital 
neuralgia.  3.  PLEURODYNIA— Situated  in  the  thoracic 
muscles  and  may  be  mistaken  for  pleuritis,  or  intercostal  neu- 
ralgia from  which  it  is  differentiated  by  the  absence  of  the 
diagnostic  features  of  each.  Pain  is  excited  by  forced  breath- 
ing, coughing  and  sneezing.  4.  LUMBAGO  or  LUMBODY- 
NIA — Situated  in  the  mass  of  muscles  and  fasciae  which  oc- 
cupy the  lumbar  region.  This  is  the  most  common  variety; 
and  usually  affects  both  sides.  It  may  set  in  rapidly,  and 
become  very  severe.  Motion  of  any  kind  aggravates  the 
pain,  which  often  becomes  very  sharp  or  stabbing  in  char- 
acter. It  is  sometimes  complicated  with  acute  sciatica,  when 
the  suffering  is  agonizing."     (Hughes.) 

Treatment. — Rest  is  very  essential  and  is  accomplished  in 
pleurodynia  by  firmly  strapping  the  side  which  is  aifected 
with  broad  strips  of  adhesive,  extending  from  the  spine  to 
the  middle  of  the  sternum.  Hot  compresses  to  the  affected 
muscles.  Other  measures  of  value  are  dry  heat,  such  as 
a  warm  flat  iron,  hot  air  baths,  massage  and  electricity.  The 
bowels  should  be  kept  regular.  Make  adjustments  according 
to  the  location  of  the  disease.  The  diet  should  consist 
principally  of  fruits  and  vegetables. 

Arthritis  Deformans  (Rheumatoid  Arthritis) 

Etiology. — The  primary  cause  is  disturbed  innervation  of 
the  affected  parts.  Predisposing  causes  are  mental  worry. 
The  disease  is  most  common  in  women. 


CONSTITUTIONAL  DISEASES  423 

Pathology. — The  cartilage  of  the  joint  first  becomes  thick- 
ened. This  is  followed  by  degeneration  and  absorption,  the 
bone  ends  being  left  bare,  and  becoming  smooth  and  ivory- 
like. The  synovial  membrane  thickens,  and  in  some  places 
is  converted  into  bone.  The  muscles  surrounding  the  joint 
become  shrunken. 

Symptoms. — Several  distinct  types  exist.  (1)  General 
Progressive  type:  (a)  Acute:  Usually  in  women  of  twenty 
to  thirty  years  or  at  the  menopause.  Invasion  like  acute  ar- 
ticular rheumatism,  many  joints,  permanent  enlargement  ap- 
pearing early,  rarely  redness  of  joints,  pain  very  severe, 
moderate  rise  of  temperature,  malaise,  anemia,  loss  of  flesh 
and  strength.  The  first  and  later  attacks  are  often  associated 
with  pregnancy,  labor  or  lactation,  (b)  Chronic :  Gradual 
onset  of  pain  or  stiffness  in  one  or  more  joints,  usually  of  the 
fingers,  then  of  corresponding  joints  of  the  other  side,  then 
of  others.  Involvement  symmetrical.  Swelling  at  first  may 
be  in  its  soft  parts,  with  joint  effusion  and  tenderness.  Pain 
may  be  slight  or  severe.  Periods  of  improvement  and  exacer- 
bation alternate,  the  joints  becoming  enlarged  and  deformed, 
often  incompletely  ankylosed  in  partial  flexion  by  thickening 
of  bone  and  soft  parts ;  joint  crepitus.  The  muscles  moving 
them  atrophy  and  there  may  be  trophic  changes  in  the  skin 
and  nails  of  the  extremities  affected.  Digestive  disturbances 
and  anemia  are  common.  Heart  not  affected.  A  few  joints 
only  may  be  attacked  or  many,  with  great  deformity,  before 
the  disease  reaches  a  period  of  inactivity.  (2)  Monarticular 
type :  Usually  in  males  over  fifty  years,  one  joint  or  a  few 
large  joints  may  be  affected,  generally  with  atrophy  of  cor- 
responding muscles.  In  the  case  of  the  hip  this  is  called 
morbus  coxae  senilis.  (3)  Heberden's  nodes :  Common  in 
women  between  thirty  and  forty  years.  Often  preceded  by 
digestive  disturbances.  With  occasional  attacks  of  local  pain 
and  swelling,  or  insidiously,  small  hard  tubercles  form  at  the 
sides  of  the  dorsal  surface  of  the  extremity  of  the  second 
phalanges.  The  presence  of  these  nodes  may  be  the  only 
sign  of  the  disease.     (Dayton.) 

Treatment. — The  chief  indications  are  to  relieve  the  pain 
and  improve  the  general  condition  of  the  patient.  This  is 
best  accomplished  by  having  him  live  in  a  Avarm,  dry  climate, 


424  SPINAL  ADJUSTMENT 

and  lead  a  hygienic  life,  eating  substances  of  the  most  nutri- 
tious  character.      Heat,    in   the   form    of   baths   or   hot   com 
presses.     Massage  is  a  valuable  adjunct  measure.     General 
adjustment;  also  make  specific  adjustments  according  to  the 
region  involved. 

Gout 

Etiology. — The  primary  cause  is  faulty  innervation,  in 
che  presence  of  which  a  deficient  amount  of  exercise,  and  the 
ingestion  of  too  much  food,  act  as  the  chief  contributing 
factors. 

Pathology. — The  blood  contains  an  excessive  amount  of 
uric  acid,  and  sodium  urate  is  deposited  in  and  about  the 
joints. 

Symptoms. — Preceding  an  acute  attack  of  gout  there  are 
malaise,  depression  and  headache.  The  attack  comes  on  in 
the  early  hours  of  the  morning,  and  disappears  toward  the 
latter  part  of  the  day,  to  recur  the  following  night.  There 
is  agonizing  pain  in  the  aflfected  joint,  which  is  usually  the 
great  toe;  the  joint  is  hot,  swollen,  and  of  a  dark  red  color. 
There  is  a  slight  rise  in  temperature.  The  urine  is  reddish, 
and  on  standing,  a  sediment  of  urates  appears.  An  acute  at- 
tack of  this  kind  lasts  a  week  or  ten  days,  and  a  number  of 
such  attacks  finally  merge  into  the  chronic  form.  In  this 
variety  the  phalangeal  joints  become  distorted  by  the 
deposition  of  urates  about  them.  Gastric  disturbances  and 
arteriosclerosis  are  present. 

Treatment. — Adjust  the  1st  cervical,  5th  and  10th  thoracic, 
and  the  5th  lumbar  vertebrae.  Give  daily  baths,  and  use  hot 
compresses  locally.  The  diet  should  consist  principally  of 
fruits  and  vegetables. 

Rickets 

Etiology. — The  prime  cause  is  malnutrition  and  unhy- 
gienic surroundings,  and  a  number  of  its  later  manifestations 
are  a  result  of  the  consequent  disturbance  of  the  nerve  supply 
to  various  parts  of  the  body. 

Pathology. — The  bones  of  the  skull,  the  long  bones,  and 
the  ribs  show  the  most  pronounced  morbid  changes.  Enlarge- 
ment of  the  parietal  and  frontal  eminences  and  flattening  of 
the  top  and  back  of  the  head  give  it  a  square  outline.     The 


CONSTITUTIONAL   DISEASES  425 

fontanels  do  not  close  until  the  second  or  third  year.  The 
long  bones  are  deficient  in  lime  salts,  and  consequently  be- 
come soft  and  bend  easily,  producing  deformities  such  as 
bow-legs  and  curvature  of  the  spine.  The  sternal  ends  of  the 
ribs  become  enlarged  and  nodular,  and  these  rows  of  nodules 
on  each  side  have  a  beaded  appearance  and  are  termed  the 
rachitic  rosary. 

Symptoms. — The  characteristic  symptoms  of  rickets  are 
disturbed  sleep,  with  profuse  perspiration  of  the  head,  gen- 
eral tenderness,  abdominal  distention,  nausea  and  vomiting, 
nervousness,  and  convulsions.  Teething  is  delayed ;  the  teeth 
are  poorly  formed.  There  is  severe  muscular  asthenia,  which 
prevents  the  child  from  sitting  erect  or  walking. 

Treatment. — Adjust  the  5th,  8th  and  10th  thoracic  verte- 
brae, and  any  other  subluxation  which  may  be  present.  The 
first  indications  are  to  provide  hygienic  surroundings  and 
proper  food  for  the  child.  If  the  child  is  nursing  and  the 
mother's  milk  is  poor,  cow's  milk  should  be  substituted  and 
properly  modified  to  suit  the  individual  requirements.  Older 
children  should  be  given  beef-juice  and  eggs,  in  addition  to 
milk.  Starches  and  sugars  should  be  avoided.  Orange  and 
lemon  juice  are  beneficial  in  many  cases.  Thin  gruels  may 
be  given. 

Scurvy 

Etiology. — Lack  of  fresh  fruit  and  vegetables  in  the  diet, 
and  unhygienic  surroundings. 

Pathology. — The  walls  of  the  blood-vessels  are  changed, 
permitting  spontaneous  hemorrhages  to  occur  into  the  skin, 
mucous  membranes,  viscera  and  muscles  and  joints.  The 
blood  is  dark  in  color  and  thin,  and  anemia  is  present.  Par- 
enchymatous degeneration  of  the  spleen,  liver  and  kidneys 
occurs.  The  gums  are  swollen  and  ulcerated  and  the  teeth 
often  fall  out.  Ulcers  of  the  ileum  and  .colon  may  be 
encountered. 

Symptoms. — The  disease  commences  gradually,  the  first 
symptoms  being  weakness,  loss  of  weight,  and  anemia.  Hem- 
orrhages next  occur  in  various  parts  of  the  body,  especially 
the  skin  and  mucous  membranes.  As  a  result  of  the  ulcera- 
tion of  the  gums,  the  breath  is  fetid.     Systemic  disturbances 


426  SPINAL  ADJUSTMENT 

are  marked.    Palpitation  of  the  heart  and  edema  of  the  ankles 
are  present. 

Treatment. — Adjust  the  4th  cervical  and  5th  thoracic  ver- 
tebrae. The  diet  should  consist  of  vegetables  and  fruits. 
Attend  to  the  hygiene. 

Hemophilia 

Etiology. — This  disease  is  hereditary,  and  is  transmitted 
by  the  mother  to  her  male  offspring.  Fathers,  however, 
transmit  it  to  their  daughters  who  are  exempt,  the  male 
subjects  usually  being  affected  by  the  disease. 

Symptoms.- — The  characteristic  feature  of  this  condition 
is  the  tendency  to  severe  hemorrhages  following  slight  in- 
juries. Frequently  such  hemorrhages  occur  spontaneously 
and  without  any  apparent  cause.  Subcutaneous  hemorrhages 
are  common,  although  bleeding  from  the  nose  and  mouth  is 
seen  in  most  cases.     The  blood  coagulates  very  slowly. 

Treatment. — Make  adjustments  according  to  the  seat  of 
the  hemorrhage.  Individuals  subject  to  this  disease  should 
guard  themselves  against  the  possibility  of  injury. 

Diabetes  Mellitus 

Etiology. — Pancreatic  disease  due  to  interference  with  the 
nerve  supply  of  that  organ.  The  disease  is  seen  most  com- 
monly in  adult  males,  and  contributing  causes  are  overwork, 
cerebral  or  spinal  injuries  and  diseases,  infectious  diseases, 
and  obesity. 

Pathology. — In  one-half  the  cases  lesions  of  the  pancreas 
are  present.  Sometimes  the  nervous  system  is  the  seat  of 
morbid  changes,  while  in  some  cases  no  pathological  changes 
at  all  exist. 

Symptoms. — There  is  loss  of  flesh  and  strength.  Increased 
thirst  and  appetite.  The  urine  is  increased  in  quantity,  of  a 
high  specific  gravity,  and  a  pale  color ;  it  has  a  sweetish  odor ; 
it  contains  varying  amounts  of  sugar,  and  often  albumin,  ace- 
tone, and  diacetic  acid.  Other  secretions  are  diminished, 
causing  dryness  of  the  skin  and  mouth,  and  constipation. 
The  temperature  is  subnormal.     Coma  frequently  developes. 

Boils  and  carbuncles,  eczema,  pneumonia,  tuberculosis, 
arteriosclerosis,   neuritis,  herpes   zoster,  perforating  ulcer   of 


COXSTITUTTONAL  DISEASES  427 

the  foot,  sterility,  cataract,  optic  atrophy,  retinitis,  and  diabetic 
coma  are  the  most  common  complications. 

Treatment. — Adjust  the  1st  cervical  and  the  6th,  8th  and 
10th  thoracic  vertebrae.  The  diet  should  be  so  regulated  as 
to  exclude  or  at  least  to  reduce  to  a  minimum  the  quantity  of 
starches  and  sugars.  Fresh  air,  daily  bathing,  and  regular 
exercise  are  essential  factors  to  be  followed  in  the  treatment. 
The  rooms  occupied  by  the  patient  should  be  well  ventilated. 
The  use  of  various  mineral  waters  is  very  beneficial.  Exer- 
cises should  be  taken  daily,  according  to  the  patient's 
strength,  care  being  taken  to  prevent  overexertion.  Flannel 
underclothing  should  be  continuously  worn. 

Diabetes  Insipidus 

Etiology. — The  primary  cause  of  the  excessive  secretion 
of  urine  consists  in  dilatation  of  the  renal  vessels,  the  result 
of  paralysis  of  their  muscular  coat,  caused  by  derangement 
of  innervation,  since  the  condition  can  be  induced  experi- 
mentally by  irritating  a  certain  area  in  the  fourth  ventricle, 
or  by  section  of  portions  of  the  sympathetic  nerve.  The 
affection  is  seen  in  persons  under  the  age  of  twenty-five  years. 
Contributing  causes  may  be  various  injuries  or  diseases  of  the 
nervous  system  in  addition  to  pressure  by  subluxated  ver- 
tebrae, hysteria,  prolonged  debility,  exhaustion,  syphilis, 
malaria,  and  intense  mental  emotions. 

Symptoms. — The  characteristic  signs  of  this  disease  are 
intense  thirst  and  secretion  of  very  large  amounts  of  clear 
urine  with  very  low  specific  gravity  (1002-1006)  and 
containing  no  sugar  or  albumin. 

Treatment. — Adjust  the  1st  cervical  and  the  6th,  8th  and 
10th  thoracic  vertebrae.  Concussion  of  the  7th  cervical  ver- 
tebra. Withdrawal  of  fluids  has  no  effect  on  the  progress  of 
the  disease.  Constipation  should  be  avoided  by  the  use  of 
enemas  and  abdominal  massage.  Warm  clothing,  warm  baths, 
friction,  fresh  air,  exercise  and  so  forth,  are  useful  accessory 
methods  of  treatment. 

Obesity 

Etiology.- — Disturbed  metabolism  due  to  interference  with 
power  of  conduction  of  the  nerves  which  govern  the  metabolic 


428  SPINAL  ADJUSTMENT 

processes  in  the  organism.  Excessive  development  of  fat 
may  be  hereditary.  It  occurs  most  commonly  in  middle-aged 
persons,  sometimes  in  children.  Its  chief  contributing  causes 
are  excessive  eating  and  drinking,  especially  fats  and  starches, 
together  with  deficient  exercise. 

Symptoms. — The  fat  is  increased  in  all  places  in  which  it 
is  found  normally,  and  the  heart  and  liver  are  often  the  seat 
of  fatty  infiltration.  The  general  health  may  be  good,  or 
there  may  be  mental  and  bodily  inactivity,  indigestion,  and 
symptoms  of  fatty  heart.  The  power  of  resistance  to  disease 
is  greatly  decreased.  The  replacement  of  the  heart  muscle 
by  fat  may  induce  dilation  of  that  organ,  and  result  in  sudden 
death. 

Treatment. — Adjust  the  6th  and  10th  dorsal  vertebrae. 
When  there  is  an  accumulation  of  fat  in  a  certain  portion  of 
the  body,  the  vertebrae  of  those  spinal  segments  which  supply 
the  afifected  parts  should  also  be  adjusted.  Hot  magnesium 
sulphate  baths  are  very  useful  in  this  disease.  Beyond  this 
the  treatment  is  chiefly  dietetic.  Excess  of  all  kinds  of  food 
and  drink  should  be  avoided,  especially  starches  and  sugar. 
Hot  baths  and  massage  are  useful  adjunct  measures.  The 
patient  should  take  systematic  exercises  daily. 


CHAPTER  VI 

Diseases  of  the  Respiratory  System 

Diseases  of  the  Nasal  Passages 

Acute  Nasal  Catarrh  (Coryza;  "Cold  in  the  Head") 

Etiology. — This  disease  is  caused  by  subluxations,  which 
reduce  the  vital  resistance  of  the  mucous  membrane  lining 
the  nasal  cavities.  Atmospheric  changes,  exposure  of  the 
neck  to  a  draught  of  cold  air,  or  of  the  ankles  to  cold  and 
dampness,  changing  from  a  warm  to  a  cold  atmosphere  sud- 
denly, inhalation  of  irritant  gases  and  vapors,  dust,  and  pow- 
ders, such  as  ipecac  and  tobacco,  irritate  the  mucous  mem- 
brane of  the  nose  and  produce  reflexly  subluxations  in  the 
middle  cervical  region.  These  lesions  produce  an  impinge- 
ment of  the  nerves  to  the  mucous  lining  of  the  nose  and 
congestion  and  increased  secretion  follow  the  irritation  of  the 
nerves.  Acute  coryza  is  often  present  in  the  initial  stage  of 
the  infectious  fevers,  such  as  measles,  influenza,  and  erysipe- 
las. Syphilis,  and  potassium  iodid  in  large  doses,  may  at  times 
produce  it.     Occasionally  the  affection  seems  contagious. 

Pathology. — There  is  an  inflammation  of  the  nasal  mucous 
membrane. 

Symptoms. — The  onset  is  sudden,  with  chilly  sensations 
and  sneezing.  A  slight  rise  in  temperature  follows,  together 
with  a  mucous  or  muco-purulent  discharge  from  the  nose;  a 
mild  degree  of  prostration  is  present.  Herpes  on  the  lips 
are  frequent. 

Treatment. — Adjust  the  middle  cervical  vertebrae,  espe- 
cially the  4th.  Harden  the  body  against  cold  and  climatic 
changes  by  taking  cold  plunges  often.  Sleep  with  the  window 
open.  Mild  cases  require  no  special  therapy.  In  severe  cases, 
a  Turkish  bath  is  an  excellent  procedure,  provided  care  is 
taken  to  not  be  exposed  to  the  cold  for  some  time  thereafter. 
A  cold  may  be  aborted  by  drinking  hot  lemonade  on  going 
to  bed. 

429 


430  SPINAL  ADJUSTMENT 

Chronic  Nasal  Catarrh 

Symptoms.— In  the  simple  form  there  is  an  obstruction  of 
one  or  both  nostrils,  and  the  mucous  membrane  is  congested 
and  turgid.  In  the  hypertrophic  form,  the  same  symptoms 
are  present  in  a  greater  degree.  In  the  atrophic  form,  large 
dry  crusts  are  present  in  the  nose.  There  is  an  exceedingly 
offensive  odor,  and  anosmia. 

Treatment. — Adjust  the  4th  cervical  and  5th  thoracic  ver- 
tebrae. Wherever  possible,  the  patient  should  live  in  a  warm, 
equable  climate.  Hygienic  measures,  as  cold  plunges  and 
exercise  in  the  fresh  air,  are  valuable  measures. 

Diseases  of  the  Larynx 
Acute  Catarrhal  Laryngitis   ("Sore  Throat") 

Etiology. — When  the  condition  of  the  larynx  is  a  result 
of  faulty  innervation,  it  is  very  susceptible  to  inflammatory 
changes  when  influenced  by  the  contributing  causes.  These 
are  especially  exposure  to  cold  and  irritating  gases,  excessive 
use  of  the  voice  and  complicating  la  grippe  and  measles. 

Symptoms. — There  is  a  slight  fever  and  systemic  disturb- 
ances. Hoarseness,  aphonia,  a  brassy  cough,  and  dyspnea. 
The  disease  lasts  from  a  few  days  to  two  weeks. 

Pathology. — The  mucous  lining  of  the  larynx  is  congested 
and  swollen,  and  its  secretion  greatly  decreased  in  amount. 
Sometimes  only  sections  of  the  mucous  membrane  are 
affected.     Later  the  secretion  is  markedly  increased. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  dorsal 
vertebrae.  In  aggravated  cases  the  patient  should  go  to 
bed,  and  refrain  from  using  the  voice.  Cold  compresses 
should  be  applied. 

Chronic  Laryngitis 

Etiology. — Follows  acute  attacks  as  a  result  of  the  pro- 
duction of  reflex  spinal  lesions  which  interfere  with  the  inner- 
vation and  consequent  integrity  of  the  larynx.  Contributing 
causes  are  inhalation  of  irritating  gases  and  constant  use  of 
the  voice. 

Pathology. — The  larynx  is  congested,  and  there  is  more  or 
less  thickening  and  relaxation  of  the  vocal  cords.  Surface 
erosions,  and  small  outgrowths  on  the  cords  may  be  observed. 


DISEASES  OE  RESPIRATORY  SYSTEM  431 

Symptoms. — The  characteristic  symptoms  are  a  cough, 
with  very  little  expectoration,  hoarseness  and  pain  when  using 
the  voice.     There  may  be  complete  loss  of  the  voice. 

Treatment. — Adjust  the  4th  cervical  and  5th  dorsal  verte- 
brae. Cold  compresses  to  the  throat  several  times  a  day.  A 
change  of  climate  is  advisable. 

Edematous   Laryngitis 

Etiology. — The  primary  cause  is  the  same  as  that  of 
simple  laryngitis.  The  contributing  causes,  however,  modify 
the  course  of  the  disease.  These  are  syphilis,  tuberculosis, 
infectious  diseases,  and  retro-pharyngeal  abscess.  It  is  also 
present  when  edema  from  heart  or  kidney  diseases  is  present 
in  other  parts  of  the  body. 

Pathology.— The  mucous  membrane  of  the  glottis  is 
edematous. 

Symptoms. — Dyspnea  ending  in  symptoms  of  asphyxia, 
a  dry  cough,  aphonia  and  stridulous  breathing.  The  epig- 
lottis may  be  so  swollen  that  it  is  palpable.  Expiration  is 
difficult,  the  lower  ribs  are  contracted,  and  the  abdomen  is 
retracted. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  dorsal. 
In  many  cases  only  surgical  treatment  will  relieve  the 
condition. 

Spasmodic  Laryngitis  (Croup) 

Etiology. — This  disease  is  seen  in  children  between  the 
ages  of  one  and  six  years,  and  is  predisposed  to  by  enlarged 
tonsils,  adenoids,  rickets  and  faulty  nutrition. 

Symptoms. — The  attack  comes  on  suddenly,  during  the 
night,  with  a  dry,  brassy  cough  and  suffocation.  In  about  an 
hour  the  spasm  disappears,  breathing  becomes  normal,  the 
cough  less  harsh,  profuse  perspiration  occurs,  and  the  child 
falls  asleep  again.  If  the  case  remains  untreated  the  same 
thing  occurs  the  next  night,  and  less  severely  the  next,  after 
which  there  is  recovery. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  dorsal 
vertebrae.  Cold  sponging  is  advisable  in  severe  cases.  Dur- 
ing the  attack,  the  spasm  may  be  relieved  by  dashing  cold 
water  on  the  abdomen.  Regulate  the  bowels  and  attend  to 
the  diet. 


432  SPINAL  ADJUSTMENT 

Tonsillitis 

Etiology. — Tonsillitis  occurs  in  four  forms:  1.  Simple 
acute  tonsillitis.  2.  Follicular  Tonsillitis.  3.  Quinsy.  4. 
Chronic  tonsillitis.  Simple  acute  tonsillitis  and  follicular  ton- 
sillitis are  seen  most  commonly  during  youth,  and  are  pri- 
marily due  to  a  subluxation  in  the  middle  cervical  region, 
which  interferes  with  the  innervation  to  the  tonsils  and  ren- 
ders them  susceptible  to  inflammatory  processes  when  the 
contributing  causes  are  present.  These  are  most  commonly 
sudden  changes  in  temperature,  and  exposure  to  cold  and 
wet.  If  an  infective  process  is  present  the  previous  lack  of 
resistance  due  to  faulty  innervation  renders  the  tonsil  sus- 
ceptible to  the  invasion  of  pus-forming  organisms  and  quinsy 
results.  The  chronic  form  of  tonsillitis  is  due  to  repeated 
attacks  of  the  acute  form  owing  to  the  progressively 
diminished   resistance  of  the   tonsils. 

Pathology. — In  simple  acute  tonsillitis  the  inflammatory 
process  is  limited  chiefly  to  the  mucous  membrane  of  the  ton- 
sil. The  organ  is  enlarged  and  congested.  In  follicular 
tonsillitis  there  is  marked  desquamation  of  the  epithelium, 
which  collects  in  the  crypts,  and  there  undergoes  necrosis, 
forming  small,  cheesy  masses,  having  a  fetid  odor.  In  quinsy 
the  parenchymatous  portion  of  the  gland  is  principally  in- 
volved. Necrosis  takes  place  and  an  abscess  forms.  In 
chronic  tonsillitis  there  is  hypertrophy  of  the  entire  organ. 
The  tonsil  has  undergone  extensive  changes,  being  converted 
into  a  mass  of  fibrous  tissue  acting  as  a  foreign  body  in  the 
throat. 

Symptoms. — In  simple  acute  tonsillitis  the  characteristic 
symptoms  are :  sudden  onset,  with  chills  and  general  aching 
of  the  body;  rapid  rise  in  temperature  to  103°  or  104°  F. ; 
the  throat  is  hot  and  dry,  and  dysphagia  is  present.  In  the 
follicular  tonsillitis  the  general  symptoms  are  similar.  The 
tonsils  are  enlarged  and  red  and  the  crypts  are  filled  with 
cheesy  necrotic  matter,  showing  as  white  spots  on  the  tonsils. 

In  quinsy  the  tonsil  is  extremely  sensitive,  and  the  pain 
is  of  a  throbbing  nature.  There  is  great  rigidity  of  the  mus- 
cles of  the  neck  and  the  face  and  the  mouth  is  opened  with 
difficulty.  A  fluctuating  enlargement  may  be  palpated. 
There  are  alternating  chills  and  fever. 


DISEASES  OF  RESPJRA'IORY  SYSTEM  433 

In  chronic  tonsillitis  the  organs  are  permanently  enlarged, 
giving  the  voice  a  nasal  tone,  causing  mouth  breathing,  snor- 
ing, and  regurgitation  of  foods  through  the  nose.  Partial 
deafness  from  inflammation  of  the  Eustachian  tube  and  middle 
ear  may  develop.  There  are  recurrent  attacks  of  acute 
tonsillitis. 

Treatment. — For  acute  tonsillitis  adjust  the  1st,  2nd  and 
4th  cervical  and  the  6th  and  10th  dorsal  vertebrae.  Give 
a  high  rectal  enema.  Cold  compresses  should  first  be  applied 
to  the  neck.  Later  hot  compresses  may  be  substituted.  The 
diet  should  be  liquid. 

In  quinsy  hot  applications  should  be  applied  to  the  throat. 
If  an  abscess  forms,  surgical  measures  are  necessary,  though 
in  some  cases  early  adjustment  and  constant  application  of 
hot  compresses  may  abort  it. 

In  chronic  tonsillitis  much  has  been  accomplished  by 
spinal  adjustment  and  attention  to  the  general  health  of  the 
patient,  supplemented  by  massage.  In  some  instances, 
however,   surgical   measures  are   required. 

Diseases  of  the  Bronchial  Tubes 
Acute  Bronchitis 

Etiology. — Faulty  innervation  will  produce  a  lack  of  tone 
in  the  bronchial  mucous  membrane,  predisposing  it  to  in- 
flammation as  a  result  of  exposure  to  colds.  It  is  associated 
with  nearly  all  lung  diseases,  and  with  many  acute  infectious 
diseases,  especially  measles,  whooping-cough,  la  grippe  and 
typhoid  fever. 

Pathology. — The  mucous  lining  of  the  bronchial  tubes  is 
swollen  and  congested.  The  epithelium  peels  ofT,  and  the 
bronchi  contain  a  greater  or  less  amount  of  mucous  or 
muco-purulent  material. 

Symptoms. — There  is  a  heavy  feeling  in  the  thorax,  be- 
neath the  sternum,  pains  in  the  back,  and  chilly  sensations. 
Other  symptoms  which  then  follow  are  a  dry  cough  and  mild 
fever.  There  is  later  on  expectoration  of  mucous  or  muco- 
pus,  the  cough  continues,  but  other  symptoms  gradually 
disappear.  The  characteristic  physical  signs  are  sibilant  and 
sonorous  rales  in  the  early  stage;  later  the  rales  become 
moist,  namely  subcrepitant  and  mucous. 


434  SPINAL  ADJUSTMENT 

Treatment. — Adjust  the  6th  and  7th  cervicals  and  the  1st, 
2nd  and  4th  dorsal  vertebrae.  Useful  adjunct  measures  are 
a  hot  foot-bath  and  a  hot  drink  at  the  onset.  Cold  packs 
over  the  chest  and  inhalations  of  saline  solutions  are  very 
beneficial. 

Chronic  Bronchitis 

Etiology. — Chronic  bronchitis  follows  repeated  acute  at- 
tacks, as  a  result  of  the  impaired  resistance  of  the  bronchial 
mucous  membrane ;  during  acute  attacks  reflex  subluxations 
are  produced,  and  the  innervation  of  the  bronchi  is  deficient, 
thus  permitting-  morbid  changes  to  occur.  Contributing  causes 
are  exposure  to  cold  and  wet;  it  also  accompanies  chronic 
heart,  lung  and  kidney  afifections,  and  frequently  is  connected 
with  gout. 

Symptoms. — These  vary  greatly  and  may  be  evident  only 
during  the  winter  months.  Characteristic  symptoms  are  cough, 
worse  at  night  or  in  the  morning,  profuse,  mucopurulent,  or 
purulent  sputum,  dyspnea  on  exertion  and  slight  fever.  The 
characteristic  physical  signs  are  sibilant  and  sonorous  rales, 
subcrepitant  rales,  and  evidences  of  emphysema. 

Treatment." — Adjust  the  6th  and  7th  cervical  and  the  up- 
per dorsal  vertebrae,  especially  the  1st  and  2nd.  Patients 
should  live  in  a  dry,  warm  climate  if  possible.  A  cold  wet 
pack  should  be  applied  to  the  chest  for  about  fifteen  minutes 
every  evening  followed  by  a  brisk  rub.  Inhalations  of  steam- 
ing saline  solutions  are  useful.  Woolen  underclothing  should 
be  worn  in  cold  and  changeable  weather. 

Hay  Fever 

Etiology. — This  disease  is  due  primarily  to  a  hypersensi- 
tive condition  of  the  Schneiderian  membrane  of  the  nose,  as 
a  result  of  interference  with  the  innervation  thereof.  Predis- 
posing causes  are  a  nervous  temperament  and  nasal  abnor- 
malities. Certain  stimuli,  as  odor  of  hay,  pollen  of  plants,  and 
dust  are  the  exciting  causes. 

Symptoms. — The  leading  symptoms  are  coryza,  a  wheezy 
cough,  dyspnea,  depression.  It  occurs  at  a  particular  season 
each  year. 

Treatment. — Adjust  the  4th  cervical  and  the  1st  and  2nd 
dorsal    vertebrae.      Rectal    dilatation    is    also    very    useful    in 


DISEASES  OF  RESPIRATORY  SYSTEM  435 

many  cases.  Correct  any  nasal  abnormalities  which  may  be 
present.  Regulate  the  diet.  Exercise  in  the  fresh  air.  Each 
case  should  be  treated  on  its  own  merits,  since  what  will 
apply  in  one  individual  will  fail  in  another. 

Asthma 

Etiology. — The  primary  cause  is  irritability  of  the  nerves 
of  the  bronchial  tubes,  resulting  in  hyperesthesia  and  spas- 
modic contractions  thereof.  Contributing  causes  are  a  nerv- 
ous temperament,  climate,  heredity,  and,  reflexly,  diseases 
of  the  gastro-intestinal  or  the  genito-urinary  system. 

Symptoms. — A  paroxysm  usually  commences  in  the  night, 
with  marked  dyspnea,  which  is  expiratory,  the  patient  being 
compelled  to  sit  up  leaning  forward.  There  is  a  sense  of 
oppression  in  the  chest,  together  with  a  feeling  of  suffocation 
and  the  face  is  pale.  In  aggravated  cases  the  pulse  is  thready 
and  rapid,  the  extremities  are  cold,  and  the  body  is  covered 
with  a  profuse  perspiration.  Between  these  attacks  there  is 
more  or  less  cough,  and  expectoration  of  stringy,  viscid  mucus. 

Treatment. — Adjust  the  2nd  and  3rd  dorsal  vertebrae  in 
bronchial  asthma.  In  cardiac  asthma  adjust  the  4th  dorsal 
vertebra.  For  neurotic  asthma  adjust  the  6th  dorsal  vertebra. 
For  renal  asthma  adjust  the  10th  dorsal  vertebra.  For  symp- 
tomatic asthma,  adjust  as  indicated  by  a  causative  factor. 
Interference  with  the  ganglion  impar  often  is  a  cause  for  the 
persistence  of  asthma,  and  in  such  cases  rectal  dilatation  is 
very  good.  Concussion  is  useful  in  asthma,  and  the  3rd  to 
8th  dorsal  spinous  processes  should  be  concussed,  in  these 
cases.  For  cardiac  asthma  concussion  of  the  spinous  process 
of  the  7th  cervical  vertebra  is  advised.  For  bronchial  asth- 
ma concussion  of  the  4th  and  5th  cervical  vertebrae  is  best. 
Remove  the  cause  if  possible.  A  great  factor  in  the  treat- 
ment of  these  cases  is  a  change  of  climate.  The  evening  meal 
should  be  light.    Hygienic  measures  must  not  be  lost  sight  of. 

Diseases  of  the  Lungs 

Congestion  of  the  Lungs 
Pulmonary   congestion    may   be   either   active   or   passive. 
Active  congestion  is  the  first  stage  of  lobar  pneumonia,  and 
is  also  produced  by  the  inhalation  of  irritant  gases  and  dust 


436  SPINAL  ADJUSTMENT 

particles,  and  by  closure  of  the  vessels  of  other  portions  of 
the  lungs. 

Passive  congestion  is  of  two  kinds :  Mechanical  and 
hypostatic. 

1.  Mechanical  Congestion: 

Etiology. — This  is  due  to  interference  with  the  return  flow 
of  the  blood  to  the  heart,  as  in  valvular  disease,  dilatation,  or 
pressure  on  the  vessels. 

Symptoms. — While  the  heart  is  perfectly  compensating 
no  symptoms  are  present.  If  compensation  fails,  dyspnea, 
cough  and  expectoration  occur. 

2.  Hypostatic    Congestion : 

Etiology. — The  common  cause  of  this  form  of  congestion 
is  lying  in  the  dorsal  position  for  a  long  time.  It  also 
accompanies  prolonged  fevers  and  chronic  diseases. 

Symptoms. — The  characteristic  symptoms  and  signs  are 
dyspnea,  cough,  haemoptysis,  dullness  on  percussion  over 
the  lower  part  of  thorax,  subcrepitant  and  mucous  rales,  and 
bronchial  breathing. 

Treatment. — The  treatment  consists  in  determining  the 
exact  cause  of  the  condition,  and  employing  measures  directed 
toward  the  relief  thereof. 

Pulmonary  Edema 

Etiology. — Pulmonary  edema  is  the  result  of  stasis  of  the 
blood,  due  to  the  outflow  of  venous  blood  in  the  lung  meet- 
ing an  obstacle  that  cannot  be  overcome  by  the  right  ventri- 
cle of  the  heart.  This  condition  is  seen  in  failing  compensa- 
tion of  the  heart,  alcoholism,  and  nephritis. 

Symptoms. — The  condition  may  appear  suddenly  or  the 
onset  may  be  gradual.  Characteristic  symptoms  are  dyspnea, 
cough,  expectoration  of  frothy  blood-stained  sputum,  loud 
mucous  rales,  slight  dulness  at  base  of  thorax,  rise  in 
temperature  and  cyanosis. 

Treatment. — Adjust  the  3rd  cervical  and  3rd  dorsal  verte- 
brae; also  the  10th  dorsal.  Apply  cold  compresses  over 
the  chest,  and  heat  to  the  feet. 

Pulmonary  Hemorrhage 
Etiology. — Hemoptysis  is  a  symptom  rather  than  a  dis- 
ease entity,  and  is  seen  in  tuberculosis,  pneumonia,  and  other 


DISEASES  OF  RESPIRATORY  SYSTEM  437 

lung  affections.  It  also  is  met  with  in  infectious  fevers, 
hemophilia,  purpura,  and  heart  and  liver  diseases.  Sometimes 
it  occurs  without  any  demonstrable  cause. 

Symptoms. — The  expectoration  of  blood  is  accompanied 
by  coughing,  and  the  blood  is  bright  red  and  frothy.  Mucous 
and  subcrepitant  rales  are  heard.  There  is  sometimes  severe 
pain  beneath  the  sterum,  and  dyspnea  may  become  marked. 

Treatment. — Adjust  the  4th  cervical  and  2nd  dorsal  verte- 
brae. Complete  rest  is  indicated,  and  cold  compresses, 
preferably  an  ice-bag,  should  be  applied  to  the  chest. 

Bronchopneumonia 

Etiology. — Bronchopneumonia  is  nearly  always  secondary 
to  some  other  disease  as  a  complication  of  measles,  scarlet 
fever,  whooping  cough,  influenza,  diphtheria,  and  bronchitis. 
It  may  also  complicate  Bright's  disease,  valvular  diseases  of 
the  heart,  and  all  infectious  fevers.  It  may  also  be  produced 
by  drawing  food  particles  into  the  lung,  or  by  inhalation  of  dust. 

Symptoms. — The  characteristic  symptoms  and  signs  of  this 
disease  are  a  sudden  rise  of  temperature  in  the  course  of  a 
pre-existing  aft'ection,  together  with  dyspnea,  increased  pulse 
and  respiration  rate,  and  cough.  There  is  an  expression  of 
great  anxiety  on  the  face.  Cyanosis  may  develop.  On  aus- 
cultation both  dry  and  moist  rales  are  heard,  especially  over 
the  back. 

Treatment. — Adjust  the  3rd  cervical  and  the  1st  and  3rd 
dorsal  vertebrae ;  also  the  10th  dorsal.  Hot  packs  over  the 
chest  are  very  beneficial.  In  all  diseases  complicated  by 
i:)ronchopneumonia  guard  against  exposure  to  cold  and  wet, 
until  the  predisposing  disease  is  cured.  In  acute  infectious 
diseases  keep  the  mouth  carefully  cleansed.  The  temperature 
of  the  room  should  be  kept  the  same  at  all  times  and  about 
68°.  The  diet  should  be  liquid  and  consist  principally  of 
albumin  water  and  milk  broths.  For  high  fever,  and  cere- 
bral symptoms,  use  the  wet  pack,  or  give  a  gradually  cooled 
bath.  For  pain  in  the  chest,  apply  hot  compresses.  For 
cardiac  failure,  give  alternating  hot  and  cold  douches. 

Lobar  Pneumonia  (Croupous  Pneumonia;  Lung  Fever) 

Etiology. — The  primary  and  indirect  cause  is  diminished 
resistance,   due   to  faulty   innervation.      Predisposing  causes 


438  SPINAL  ADJUSTMENT 

are  exposure  to  cold,  trauma  and  a  previous  attack.  The 
direct  cause  is  the  micrococcus  lanceolatus,  pneumococcus,  or 
diplococcus  pneumoniae. 

Pathology. — One  or  more  entire  lobes  of  the  lung  are  first 
congested,  the  capillaries  being  greatly  distended.  Red  he- 
patization in  which  the  alveoli  are  filled  with  leucocytes,  red 
blood  cells  and  fibrin,  and  dead  epithelial  cells ;  the  lung  dur- 
ing this  stage  is  of  a  deep  red  color,  very  friable,  and  sinks 
in  water.  During  the  stage  of  gray  hepatization,  the  exudate 
consists  principally  of  leucocytes  and  is  becoming  necrotic, 
giving  the  lung  a  gray  color. 

Symptoms.- — There  usually  are  no  premonitory  symptoms, 
the  onset  being  very  sudden,  with  a  chill.  This  is  followed 
by  a  rapid  rise  in  temperature  to  104°-105°.  Characteristic 
symptoms  are  sharp  pains  in  the  affected  side,  flushed  cheek 
on  the  affected  side,  cough,  which  at  first  is  dry,  harsh  and 
painful  and  later  is  accompanied  by  expectoration  of  a  viscid 
rusty-colored  sputum ;  marked  dyspnea. 

The  characteristic  physical  signs  of  the  first  stage  of  pneu- 
monia are  the  crepitant  rales.  The  characteristic  signs  of 
the  second  and  third  stage  are  increased  vocal  fremitus, 
dulness  on  percussion,  bronchial  breathing  and  bronchial 
voice. 

Treatment. — Adjust  the  3rd  cervical  and  the  1st,  3rd  and 
10th  dorsal  vertebrae.  The  diet  should  be  light  and  large 
amounts  of  water  should  be  given  the  patient.  The  patient 
should  remain  in  bed  and*  an  ice-cap  applied  to  the  head.  If 
pain  is  severe  cold  compresses  should  be  applied  to  the  chest. 
When  the  heart  is  weak  sponge  baths  and  administration  of 
whiskey  are  indicated. 

Diseases  of  the  Pleura 
Pleurisy 

Etiology. — Primary  pleurisy  is  due  to  defective  innerva- 
tion of  the  pleurae,  superinduced  by  exposure  to  cold  and 
wet.  Injuries  of  the  chest  walls  may  also  cause  it.  Sec- 
ondary pleurisy  accompanies  pneumonia,  tuberculosis,  peri- 
carditis, measles,  scarlet  fever,  smallpox,  rheumatism  and 
Bright's  disease.     Chronic  pleurisy  follows  an  acute  attack, 


DISEASES  OF  RESPIRATORY  SYSTEM  439 

as  a  result  of  a  low  grade  of  resistance  induced  thereby  in 
the  pleura.  It  also  may  be  the  result  of  tuberculosis, 
alcoholism  and  cancer. 

Pathology. — Pleurisy  is  divided  into  four  stages.  The 
first  stage  is  called  the  dry  stage;  the  pleural  surfaces  are 
dry  and  roughened  instead  of  moist  and  smooth  and  glistening 
as  they  are  in  health.  The  second  or  plastic  stage  is  char- 
acterized by  an  effusion  of  a  small  amount  of  viscid  fluid, 
which  covers  the  surfaces  of  the  pleura,  and  has  a  tendency 
to  cause  them  to  adhere  to  each  other.  The  third  stage,  or 
stage  of  liquid  effusion,  is  characterized  by  the  presence  of 
a  greater  or  less  amount  of  fluid  in  the  pleural  sac.  The  fourth 
stage,  or  stage  of  absorption,  is  that  during  which  the  fluid 
is  becoming  gradually  absorbed.  If  the  effusion  is  on  the 
left  side,  the  heart  is  pushed  to  the  right,  and  if  the  eff'usion 
is  on  the  right  side,  the  heart  is  forced  over  to  the  left  still 
further.  The  lungs  are  compressed,  and  displaced  upward 
and  against  the  spinal  column.  In  chronic  pleurisy  the  fluid 
which  is  present  is  pus,  which  is  walled  off'  by  adhesions, 
which  are  thrown  about  the  infected  area. 

Symptoms.- — The  acute  variety  begins  suddenly  with  a 
chill,  followed  by  sharp  pains  in  the  aff'ected  side,  which  are 
increased  by  coughing  and  respiratory  movements.  Other 
symptoms  are  rapid,  shallow  respiration,  a  short,  dry  cough, 
rise  in  temperature,  and  rapid  pulse.  As  the  licjuid  accumu- 
lates, the  pain  abates,  while  dyspnea  increases,  cough  becomes 
aggravated,  the  heart  action  is  impaired,  and  cyanosis  de- 
velops. As  the  fluid  becomes  absorbed,  the  symptoms  become 
less  pronounced. 

The  subacute  variety  begins  gradually  after  cold  and  ex- 
haustion, in  individauls  in  whom  the  resistance  is  low,  as  a 
result  of  faulty  innervation.  The  patients  usually  complain 
of  a  sense  of  fatigue,  .dyspnea  on  exertion,  evening  rise  in 
temperature,  night  sweats,  and  a  short,  hacking  cough  with 
little  or  no  expectoration.  The  pulse  is  weak,  thready  and 
rapid.     No  pain  is  present. 

The  chronic  variety  runs  a  long  course,  and  characteristic 
symptoms  are  irregular  chills  and  fever,  palpitation  of  the 
heart,  dyspnea,  night  sweats,  and  more  or  less   ])rostration. 

The  physical  signs  of  the  first  stage  are  diminished  move- 


440  SPINAL  ADJUSTMENT 

ment  of  the  affected  side,  and  a  corresponding  increase  on  the 
healthy  side.  Palpation  shows  slight  diminution  of  the 
vocal  fremitus.  Auscultation  reveals  a  friction  sound.  Dur- 
ing the  second  stage  there  is  still  more  restricted  movement 
on  the  affected  side,  vocal  fremitus  still  more  diminished, 
resonance  on  percussion  is  lessened,  and  crackling  friction 
sounds  are  detected  on  auscultation.  During  the  third  stage 
inspection  reveals  absence  of  respiratory  movements  on  the 
affected  side,  the  intercostal  spaces  are  widened  and  bulging; 
the  vocal  fremitus  is  absent;  there  is  flatness  on  percussion, 
and  the  line  of  flatness  varies  with  changes  in  the  patient's 
position;  auscultation  reveals  absence  of  all  sounds  on  the 
affected  side ;  mensuration  shows  the  affected  side  of  the  chest 
to  be  one  or  two  inches  larger  than  the  other  side. 

Treatment. — Adjust  the  3rd  cerv-ical  and  3rd  dorsal  verte- 
brae. The  patient  should  be  placed  in  bed  at  once.  The  diet 
should  be  confined  to  liquids  or  semi-solid  substances.  Strap 
the  affected  side  with  broad  strips  of  adhesive  plaster,  to 
limit  the  movement  and  lessen  the  pain.  The  heart  should 
receive  careful  consideration. 

Pneumothorax 

Etiology.- — Perforating  wounds  of  the  chest  wall ;  pointing 
of  abscess  of  the  lungs  or  empyema  through  the  chest  wall ; 
perforation  of  the  lung  by  tubercular  excavations,  or  gan- 
grene ;  perforation  of  the  diaphragm  in  cancer  of  the  esopha- 
gus, stomach,  or  intestine. 

Pathology. — The  lung  is  compressed  against  the  spinal 
column  and  the  pleural  cavity  is  filled  with  gas. 

Symptoms. — The  presence  of  air  in  the  pleural  sac  is  a  rare 
condition ;  the  chief  symptoms  are  its  sudden  onset  with 
intense  pain  in  the  side,  dyspnea,  cyanosis  and  extreme 
prostration. 

Physical  Signs. — The  aft'ected  side  is  enlarged  and  immo- 
bile ;  the  vocal  fremitus  is  diminished  ;  tympanitic  resonance 
on  percussion.  If  fluid  is  also  present,  there  will  be  flatness 
below  its  level,  which  changes  with  alterations  in  the  patient's 
position.  The  respiratory  sounds  are  weak  or  absent.  Suc- 
cussion,  which  is  performed  by  grasping  the  patient  by  the 
shoulders,  and  vigorously  shaking  him,  produces  the  splash- 


DISEASES  OF  RESPIRATORY  SYSTEM  441 

ing    sound,    when    fluid    and    air   are    present    in    the    pleural 
cavity. 

Treatment. — That  of  pleurisy  with  effusion. 

Hydrothorax 

Etiology. — An  eli'usion  of  fluid  into  the  pleural  cavities  is 
an  accompaniment  of  dropsy  in  other  parts  of  the  body  due  to 
heart,  liver,  and  kidney  disease. 

Symptoms. — The  characteristic  signs  are  cough,  dyspnea, 
and  cyanosis.  No  signs  of  inflammation  are  present,  and 
the  pulse  and  temperature  are  normal. 

Treatment.— Adjust  the  3rd  cervical  and  3rd  dorsal  verte- 
brae, and  any  other  subluxations  which  may  be  found  after 
a  careful  spinal  analysis  has  been  made.  Diseases  of  the 
heart,  liver  or  kidneys  should  be  treated.  The  skin,  bowels 
and  kidneys  should  be  kept  active. 


CHAPTER  VII 

Diseases  of  the  Circulatory  System 
Acute  Pericarditis 

Etiology. — A  primary  inflammation  of  the  pericardium 
rarely  occurs,  but  the  disease  is  usually  due  to  other  pre- 
existing conditions,  for  example,  gout,  rheumatism,  tonsil- 
itis,  scarlet  fever,  pneumonia,  la  grippe,  infections,  and  tuber- 
culosis. Spinal  lesions  producing  impingement  of  the  sec- 
ond and  third  pair  of  dorsal  spinal  nerves  are  very  often  found 
in  this  disease,  and  indicate  that  in  part  at  least  it  is  due  to 
this  cause.  When  the  disease  has  existed  for  a  short  time 
reflex  subluxations  are  produced,  which  prevent  raj)id  recovery 
and  cause  the  condition  to  become  chronic. 

Pathology. — During  the  first  stage  the  surfaces  of  the 
pericardium  are  dry  and  roughened.  In  the  second  stage 
the  surfaces  are  covered  with  a  viscid  material.  The  third 
stage  is  characterized  by  the  formation  of  a  greater  or  less 
amount  of  serous  effusion.  This  effusion  may  become 
hemorrhagic  or  purulent. 

Symptoms.- — There  may  be  no  symptoms  until  eft'usion 
into  the  pericardium  develops.  There  may  be  slight  pain 
over  the  heart,  and  a  moderate  rise  in  temperature.  In  the 
first  stage  the  heart  action  is  irritable  and  forcible;  there  is 
no  change  in  the  area  of  cardiac  dullness  on  percussion.  The 
only  characteristic  sign  of  this  stage  is  the  pericardial  friction 
sound,  which  is  produced  by  the  rubbing  over  each  other  of 
the  roughened  surfaces  of  the  pericardium.  After  the  inflam- 
mation has  existed  for  a  short  time,  effusion  into  the  peri- 
cardial sac  takes  place.  On  inspection  we  note  the  pericardial 
area  to  be  arched  forward,  and  a  diminution  of  the  respira- 
tory movements  on  the  left  side  of  the  thorax.  Palpation 
shows  the  apex  impulse  displaced  upward  and  to  the  left ;  if, 
however,  the  amount  of  eft'usion  is  large,  the  apex  beat  will 
not  be  palpable.  If  the  apex  impulse  is  palpable  when  the 
patient  is  in  the  recumbent  posture  and  absent  when  he  is 

442 


DISEASES  OF  CIRCULATORY  SYSTEM  443 

erect,  it  is  almost  certain  that  effusion  into  the  pericardial 
sac  is  present.  On  percussion  the  area  of  cardiac  dullness  is 
first  increased  upward,  and  later  transversely.  In  this  stage 
the  pericardial  friction  sound  becomes  more  and  more  indis- 
tinct, until  finally  it  ceases  to  be  heard.  The  normal  heart 
sounds  are  very  feeble,  and  the  respiratory  sounds  are  absent 
over  the  pericardial  area.  As  recovery  takes  place  there  is 
a  gradual  return  to  normal  of  all  the  physical  signs. 

Treatment. — Adjust  the  3rd  cervical  and  the  2nd,  4th, 
and  6th  dorsal  vertebrae.  The  patient  should  be  placed  in 
bed,  and  absolute  rest  enforced.  The  diet  should  be  fluid ;  if, 
however,  the  amount  of  eiTusion  is  large,  a  dry  diet  is  indi- 
cated. Either  an  icebag  or  hot  magnesium  sulphate  com- 
presses over  the  pericardium  are  indicated.  If  the  amount  of 
efifusion  is  so  large  as  to  cause  dyspnea  or  other  pressure 
symptoms,  surgical  measures  are  necessary. 

Chronic  Pericarditis 

Etiology. — The  chronic  form  usually  follows  acute  peri- 
carditis, and  this  is  due  to  the  reflex  production  of  spinal 
lesions  which  produce  impingement  of  the  nerves  which 
control  the  heart.  Were  these  subluxations  corrected  as  they 
developed  in  the  acute  form,  it  is  unlikely  that  the  chronic 
form  would  result. 

Pathology. — The  pericardium  is  thickened  and  covered 
with  fibrin.  Adhesions  are  present  either  between  the  two 
layers  of  the  pericardium  or  between  the  pericardium  and 
pleura.  The  heart  is  very  often  found  dilated  and  hyper- 
trophied. 

Symptoms. — These  are  frequently  not  characteristic,  but 
may  be  those  of  enlargement  of  the  heart  or  failure  of  com- 
pensation. The  apex  beat  is  diffused,  the  area  of  cardiac 
dulness  increased,  and  the  heart  action  is  irregular. 

Treatment. — Adjust  the  3rd  cervical  and  the  2nd  and  4th 
dorsal  vertebrae.  Moderate  exercise  and  baths.  Otherwise 
the  treatment  is  symptomatic. 

Chronic  Myocarditis 

Etiology. — The  primary  and  indirect  cause  of  this  dis- 
ease is  the  progressive  diminution  of  nerve  force  which  ac- 


444  SPINAL  ADJUSTMENT 

companies  old  age,  in  which  period  of  life  the  condition  gen- 
erally occurs.  It  also  accompanies  pericarditis  and  endo- 
carditis and  disease  of  the  coronary  arteries.  Persons  sub- 
ject to  arteriosclerosis  as  a  result  of  deposition  of  lime  salts 
in  the  arteries  from  faulty  elimination  also  are  subject  to 
acute  myocarditis. 

Pathology. — There  is  no  inflammation  of  the  heart  mus- 
cle but  rather  a  replacement  of  the  heart  muscle  with  fibrous 
tissue.  Hypertrophy  of  the  heart  may  occur  to  compensate 
for  the  loss  of  muscle  tissue,  and  this  is  later  followed  by 
aneurysm. 

Symptoms. — There  may  be  no  definite  symptoms.  Those 
which  may  be  present  are  dyspnea,  rapid  heart  action,  palpi- 
tation, angina  pectoris,  cardiac  asthma,  symptoms  of  collapse, 
and  mental  disturbances.  In  other  cases  the  symptoms  of 
broken  compensation  are  present,  and  as  a  result  of  the 
hypertrophy  the  area  of  cardiac  dullness  is  increased. 

Treatment. — Adjust  the  3rd  cervical  and  the  2nd  and  4th 
dorsal  vertebrae.  The  Schott  or  Nauheim  treatment  which 
consists  of  graduated  resisted  exercise  is  a  valuable  adjunct 
in  the  treatment  of  these  cases.  Rectal  dilatation  has  been 
successfully  employed  in  this  disease  and  is  advised.  Baths 
are  of  value  and  should  be  given  about  three  times  a  week. 
The  patient  should  be  moderate  in  all  things. 

Acute  Myocarditis 

Etiology. — When  during  the  course  of  an  acute  infectious 
disease  reflex  spinal  lesions  affecting  the  nerves  that  control 
the  heart  are  produced,  acute  myocarditis  frequently  develops. 
This  is  especially  true  in  typhoid  fever,  scarlet  fever,  and 
diphtheria.  It  also  accompanies  acute  pericarditis  and  en- 
docarditis, in  which  the  muscular  coat  of  the  heart  becomes 
afTected  simply  through  extension  of  the  inflammation  to  it. 

Pathology. — There  is  granular  degeneration  of  the  mus- 
cle cells,  and  sometimes  small  abscesses  of  the  heart  wall 
develop. 

Symptoms. — The  characteristic  symptoms  of  this  disease 
are  precordial  pain,  weak  circulation,  feeble  heart  action,  and 
symptoms  of  collapse.  The  physical  signs  are  those  of  sepsis 
and  mild  dilatation  of  the  heart. 


DISEASES  OF  CIRCULATORY  SYSTEM  445 

Treatment. — Adjust  the  3rd  cervical  and  the  2nd  and  4th 
dorsal  vertebrae.  Hot  compresses  over  the  heart.  Treat  the 
accompanying  disease. 

Acute    Endocarditis 

Etiology. — There  are  two  varieties  of  the  disease:  (1)  The 
simple  form ;  (2)  The  malignant  form.  The  simple  form  of 
endocarditis  usually  follows  rheumatic  fever,  typhoid  fever, 
diphtheria,  tonsillitis,  chorea,  and  less  frequently  other  infec- 
tious diseases.  The  malignant  form  sometimes  follows  any 
of  the  above  diseases,  in  addition  to  which  it  often  accom- 
panies sepsis,  tuberculosis,  Bright's  disease,  erysipelas,  and 
gonorrhea.  In  all  cases  reflex  subluxations  are  produced  in 
those  spinal  segments  from  which  the  heart  receives  its  inner- 
vation ;  these  tend  to  aggravate  the  condition,  and,  unless 
corrected  cause  it  to  be  prolonged  into  the  chronic  form. 

Pathology. — In  plastic  or  simple  exudative  endocarditis 
there  is  a  tendency  to  overgrowth  of  the  valvular  portions  of 
the  endocardium,  as  a  result  of  the  products  of  the  inflam- 
mation, namely  the  fibrin,  blood-platelets  and  leucocytes  be- 
coming organized.  The  aortic  and  mitral  valves  are  most 
commonly  affected.  In  malignant  or  ulcerative  endocardi- 
tis portions  of  the  valves  are  destroyed  as  a  result  of  the 
ulceration. 

Symptoms. — In  the  simple  form  there  may  be  very  few 
symptoms,  among  which  may  be  mentioned  dyspnea,  dis- 
turbed cardiac  action,  nausea  and  vomiting,  and  a  moderate 
rise  in  temperature.  In  the  malignant  form  emboli  are  quite 
common  and  among  the  eiifects  produced  by  them  may  be 
enumerated  hematuria,  spitting  of  blood,  local  gangrene,  paral- 
ysis, and  hemorrhage  of  the  retina.  The  fever  is  high  and 
may  be  accompanied  by  chills  and  sweats  as  in  sepsis,  or  by 
prostration,  delirium,  and  coma  as  in  typhoid  fever,  or  the 
disturbances  may  be  chiefly  cerebral.  These  varying  symp- 
toms all  depend  upon  the  comparative  resistance  of  the  re- 
spective parts  of  the  body,  those  of  low  resistance  as  a  result 
of  deficient  innervation  being  the  ones  which  will  be  most 
readily  affected. 

Treatment. — Adjust  the  3rd  cervical  and  the  2nd,  4th  and 
6th  dorsal  vertebrae.    Hot  magnesium  sulphate  compress  over 


446  SPINAL  ADJUSTMENT 

llie  precordial  region.  Rest  and  avoidance  of  exposure  dur- 
ing attacks  of  rheumatism,  chorea,  or  diseases  with  which 
endocarditis  is  commonly  associated.  Absolute  rest  after  the 
disease  develops.  For  over-action  of  the  heart,  an  ice  pack 
over  the  pericardium,  and  concussion  of  the  transverse  proc- 
esses of  the  1st  and  2nd  dorsal  vertebrae,  for  its  stimulating 
effects  upon  the  4th  thoracic  nerve,  which  produces  an  in- 
hibitory effect  on  the  heart  movements.  Diet  should  be 
chiefly  liquid,  but  not  restricted.  Stimulation  as  needed. 
Avoid  early  exertion  after  convalescence.  Rectal  dilatation 
is  very  useful  in  many  cases. 

Chronic  Endocarditis   (Chronic  Valvular  Disease) 

Etiology. — When  in  the  course  of  an  acute  endocarditis 
the  reflex  spinal  lesions  which  must  occur,  as  a  result  of  the 
excessive  flow,  to  the  segments  which  control  the  heart,  of 
afferent  impulses  are  left  uncorrected,  the  disease  merges  into 
the  chronic  form.  This  is  due  to  the  fact  that  the  impinge- 
ment of  the  nerves  to  the  heart  interferes  with  its  innervation 
and  permits  of  inflammatory  changes  which  would  otherwise 
not  be  possible.  Alost  such  cases  may  be  traced  to  rheuma- 
tism, infectious  diseases,  and  chorea  from  which  the  acute 
form  resulted.  An  endocarditis  which  is  chronic  from  the 
very  onset  may  be  caused  by  alcoholism,  syphilis,  gout,  or 
excessive  muscular  exertion.  In  the  aged  atheromatous  or 
fibroid  changes  in  the  lining  of  the  heart  may  produce  chronic 
endocarditis.     Chronic  Bright's  disease  may  also  cause  it. 

Pathology. — This  is  the  same  as  that  of  the  acute  form 
after  the  process  has  become  fully  developed,  namely  after 
there  has  been  either  thickening  of  the  valves  or  partial 
destruction  of  one  or  more  of  their  segments. 

Symptoms. — When  the  heart  is  compensating  for  the  leak- 
age, there  may  be  no  symptoms.  When,  however,  compen- 
sation begins  to  fail,  distress  over  the  heart,  irregular  car- 
diac action,  palpitation,  dyspnea,  vertigo,  edema  of  the  ankles, 
and  other  symptoms  develop.  When  compensation  is  mark- 
edly impaired,  the  above  symptoms  are  aggravated,  in  addi- 
tion to  which  passive  congestion  in  various  parts  and  organs 
of  the  body  develops,  with  its  concomitant  symptoms,  as 
bronchitis,  pulsating  liver,  scanty,  albuminous  urine,  edema 


DISEASES  OF  CIRCULATORY  SYSTEM  447 

of  the  luniks,  anasarca,  and  j^^astroenteritis.     The  heart  action 
is  irregular  and  the  sounds  are  feeble.    Anemia  is  present. 

Varieties. — 1.  Aortic  Regurgitation.  2.  Aortic  Stenosis. 
3.  Mitral  Regurgitation.  4.  Mitral  Stenosis.  5.  Pulmon- 
ary Regurgitation.  6.  Pulmonary  Stenosis.  7.  Tricuspid 
Regurgitation.     8.  Tricuspid  Stenosis. 

1.  AORTIC  REGURGITATION.— The  apex  beat  is  dis- 
placed downward  and  to  the  left.  The  area  of  heart  dullness 
is  increased.  A  murmur  heard  with  and  just  after  the  second 
sound  behind  the  sternum  is  heard. 

2.  AORTIC  STENOSIS.— Slight  increase  of  the  heart 
dullness.  A  murmur  is  heard  with  the  first  sound  of  the 
heart,  behind  the  sternum.  Aortic  murmurs  are  the  only 
ones  which  are  transmitted  into  the  vessels  of  the  neck. 

3.  MITRAL  REGURGITATION.— The  apex  beat  is  dis- 
placed to  the  left  and  downward.  The  area  of  heart  dullness 
is  increased.  A  murmur  is  heard  with  the  first  sound  of  the 
heart  with  the  greatest  intensity  at  the  apex,  and  is  trans- 
mitted toward  the  left  and  around  to  the  back  on  a  line  with 
the  apex  beat.     The  second  pulmonic  sound  is  accentuated. 

4.  MITRAL  STENOSIS.— There  is  lateral  increase  in  the 
heart  dullness.  The  pulse  is  small.  A  murmur  is  heard  dur- 
ing diastole,  just  preceding  the  first  sound  (if  the  heart.  The 
pulmonary  second  sound  is  accentuated. 

5.  PULMONARY  REGURGITATION.— The  murmur  is 
heard  best  at  the  second  intercostal  space  to  the  left  of  the 
sternum.  It  is  heard  with  and  following  the  second  sound 
of  the  heart. 

6.  PULMONARY  STENOSIS.— The  murmur  is  heard 
best  at  the  second  intercostal  space,  to  the  left  of  the  sternum, 
and  occurs  with  the  first  sound  of  the  heart. 

7.  TRICUSPID  REGURGITATIOiN.— Pulsating  jugu- 
lars. Increase  of  heart  dullness  toward  the  right  side.  V^en- 
ous  engorgement  is  pronounced.  A  murmur  is  heard  with 
the  first  sound  of  the  heart,  over  the  uncovered  triangular 
space. 

8.  TRICUSPID  STENOSIS.— The  cardiac  dullness  is  in- 
creased toward  the  right  side.     A  murmur  is  heard  just  pre- 


448  SPINAL  ADJUSTMENT 

ceding  the  first  sound  of  the  heart,  over  the  lower  sternum, 
and  is  not  transmitted. 

Treatment. — Adjust  the  2nd  and  4th  dorsal  vertebrae  and 
any  others  which  may  be  found  after  a  careful  spinal  analysis 
has  been  made.  Concussion  of  the  7th  cervical  vertebrae. 
Tepid  baths,  and  hot  compresses  over  the  precordial  region. 
Rectal  dilatation.  When  compensation  is  perfect,  a  regular, 
quiet  mode  of  life  should  be  followed,  and  all  mental  excite- 
ment, overwork,  and  worry  be  studiously  avoided.  Moderate 
exercise  is  very  beneficial  in  these  cases,  but  the  patient  should 
be  warned  of  the  dangers  of  excessive  physical  exertion,  as 
running  up  stairs,  excessive  work,  etc.  Exposure  to  damp 
and  cold  should  be  guarded  against.  High  altitudes  should 
be  avoided,  although  the  author  has  seen  cases  whose  heart 
action  was  better  in  high  altitudes  than  in  low.  The  diet 
should  be  dry  and  moderate,  and  all  stimulants  should  be 
eschewed.  Tobacco  and  alcohol  should  never  be  used.  When 
compensation  is  disturbed  absolute  rest  in  bed  is  indicated. 
Consultation  in  such  cases  is  always  advisable. 

Hypertrophy  of  the  Heart 

Etiology .^ — Chronic  diseases  of  the  lung,  for  example,  em- 
physema and  fibroid  phthisis ;  chronic  pericarditis  or  endo- 
carditis. Drugs,  as  tobacco  and  alcohol.  Anything  which 
causes  increased  resistance  in  the  circulation,  for  example, 
arteriosclerosis,  aneurysm,  Bright's  disease,  or  gout. 

Pathology. — The  heart  is  increased  in  size.  The  walls 
of  that  part  of  the  heart  which  is  involved  are  thicker  than 
normal  and  the  muscle  is  dark  in  color  and  very  dense.  Arte- 
riosclerosis may  follow  on  account  of  the  increased  strain  put 
upon  the  vessels,  and  as  a  result  of  this  apoplexy  is  apt  to 
occur. 

Symptoms. — The  symptoms  depend  on  the  extent  of  the 
enlargement.  If  the  heart  is  only  enlarged  suf^ciently  to 
compensate  for  valvular  lesions,  or  other  disturbances  in  the 
circulation  as  mentioned  under  the  head  of  etiology,  no  symp- 
toms will  be  present.  But  when  the  enlargement  is  greater 
than  the  requirements,  it  is  shown  by  the  following  symp- 
toms :  The  heart  action  is  increased  in  frequency  and  very 
forcible ;  there  are  also  headache,  vertigo,  dyspnea  on  exer- 


DISEASES  OF  CIRCULATORY  SYSTEM  449 

tion,  redness  of  the  face  and  eyes,  nose-bleed,  cough,  tinnitus, 
distress  in  the  precordial  region,  disturbed  sleep,  dreaming, 
and  starting  during  sleep.  The  arteries  are  full,  and  the 
pulse  is  hard.  The  carotid  arteries  and  others  pulsate  very 
forcibly. 

Treatment. — Adjust  the  2nd  and  4th  dorsal  vertebrae. 
Spinal  concussion  of  the  7th  cervical  vertebra.  Avoid  all  ex- 
cesses, as  mental  and  physical  over-exertion.  Keep  up  the 
general  nutrition.  All  stimulants  such  as  alcohol,  tea,  coffee, 
and  tobacco,  should  be  interdicted. 

Dilatation  of  the  Heart 

Etiology. — The  common  causes  of  dilatation  of  the  heart 
are  impairment  of  the  nutrition  of  the  heart  muscles,  harden- 
ing of  the  coronary  arteries,  and  anemia.  In  addition  to  these 
causes,  those  operating  to  produce  enlargement  of  the  heart 
by  thickening  of  its  walls,  namely,  hypertrophy,  also  cause 
dilatation. 

Pathology. — Dilatation  of  the  heart  is  usually  associated 
with  hypertrophy,  and  affects  most  often  the  right  side  of 
the  heart.  If  the  degree  of  dilatation  is  marked,  the  valves 
will  be  unable  to  close  the  orifices  which  they  normally  guard. 

Symptoms. — The  symptoms  which  are  present  in  dila- 
tation of  the  heart,  are  all  due  to  weakening  of  the  heart  action, 
as  a  result  of  thinning  of  its  walls,  and  are  as  follows :  The 
pulse  is  feeble,  symptoms  of  collapse  are  frequent,  there  is 
headache,  cough,  dyspepsia  and  constipation,  dyspnea,  scanty 
urine,  dizziness,  mental  dullness,  and  finally  edema  of  the 
ankles  develops. 

Treatment. — Adjust  the  2nd  and  4th  dorsal  vertebrae. 
Concussion  of  the  spinous  process  of  the  7th  cervical  and  4th 
dorsal.  The  general  nutrition  should  be  improved  in  as  far 
as  possible,  by  a  liberal  diet.  The  amount  of  exercise  taken 
should  be  moderate,  and  the  skin,  bowels,  and  kidneys  should 
be  kept  active.  Exercise  is  employed  in  three  different  ways, 
or  sometimes  by  a  combination  of  these  methods :  (a)  Passive 
exercise  and  massage  (Swedish  or  Ling  plan)  ;  (b)  Move- 
ments with  limited  resistance  (Schott  plan,  which  is  really  a 
modification  of  the  Swedish  method)  ;  (c)  The  Oertel  method 
of  climbing. 


450  SPINAL  ADJUSTMENT 

Angina   Pectoris 

Etiology. — This  disease  is  usually  due  to  hardening  of  the 
coronary  arteries.  It  is  seen  more  in  men  than  in  women. 
It  occurs  most  commonly  during  middle  life.  It  is  very  often 
associated  with  aortic  insufficiency,  or  when  the  pericardium 
is  adherent. 

Symptoms. — Following  a  day  of  excessive  physical  or 
mental  exertion,  the  patient  awakens  during  the  middle  of 
the  night,  suffering  from  an  agonizing  pain  over  the  heart, 
accompanying  which  is  a  sense  of  impending  dissolution.  The 
pain  usually  radiates  upward  to  the  left  shoulder,  and  down 
the  left  arm.  The  attack  lasts  from  a  few  seconds  to  possibly 
ten  minutes.  Following  the  attack,  gas  and  acid  eructation, 
profuse  urination,  and  exhaustion  are  present. 

Treatment. — Adjust  the  2nd  and  4th  dorsal  vertebrae.  In 
addition  to  these  adjustments,  give  others  for  the  relief  of 
any  possible  causative  factors.  Concussion  over  the  9th  to 
the  12th  thoracic  vertebrae  is  also  very  beneficial.  Hot  baths 
should  be  used.  The  Nauheim  treatment,  especially  the  hot 
baths,  are  indicated  in  this  condition.  The  constant  current, 
with  the  positive  pole  over  the  sternum,  and  the  negative 
pole  over  the  lower  vertebrae,  has  been  used  with  success,  in 
conjunction  with  spinal  adjustment.  Careful  dieting  is  indi- 
cated, to  prevent  the  occurrence  of  flatulence  and  constipation. 
All  mental  strain  and  physical  exertion  should  be  avoided. 

Fatty   Heart 

Etiology. — Fatty  degeneration  of  the  heart  accompanies 
various  conditions  the  chief  of  which  are  wasting  diseases, 
anemia,  alcoholism,  arsenic  or  phosphorous  poisoning,  and 
diseases  of  the  coronary  arteries,  pericarditis,  or  enlargement 
of  the  heart.     It  is  seen  most  frequently  in  old  age. 

Pathology. — The  cells  of  the  muscle  fibres  are  degenerated 
and  broken  down,  while  between  the  muscle  fibres  there  are 
present  numerous  fat  lobules. 

Symptoms. — There  are  usually  no  symptoms  until  the  heart 
becomes  dilated,  and  the  symptoms  then  are  those  of  dilata- 
tion of  the  heart.     Pulse  is  usually  very  slow,  on  account  of 


DISEASES  OF  CIRCULATORY  SYSTEM  451 

the  weakness  of  the  heart  muscle,  which  is  largely  replaced  by 
fat.  Dyspnea,  collapse,  pain  over  the  precordial  region  are 
common  symptoms. 

Treatment. — Adjustment  of  the  2nd  and  4th  dorsal  verte- 
brae ;  concussion  of  the  7th  cervical  vertebra.  "The  Oertel 
and  Schott  treatment — gradually  increased  hill  climbing  with 
reduction  of  fluids  and  fats  in  the  diet — may  give  good  re- 
sults, especially  in  cases  with  general  obesity.  The  Schott 
or  Nauheim  method — saline  baths  charged  with  carbon  diox- 
ide and  graduated  resisted  exercise — may  be  employed  at 
Nauheim  or  in  artificail  baths  at  home."  (Dayton.)  Mental 
and  physical  exertion  should  be  avoided.  The  diet  should 
be  generous,  and  consist  of  easily  digested  substances ;  meat, 
fat  and  starches  should  be  especially  forbidden.  The  patient 
should  lie  down  for  several  hours  each  day. 

Palpitation  of  the  Heart   (Irritable   Heart) 

Etiology. — This  condition  is  due  principally  to  interference 
with  the  conduction  of  those  nerve  impulses  to  the  heart 
which  regulate  its  action ;  as  a  result  of  this,  the  inhibitory 
influence  of  these  nerves  upon  the  action  of  the  heart  is 
withdrawn,  and  increased  rapidity  of  the  cardiac  action 
results.  Among  the  contributing  causes  may  be  enumerated 
anemia,  mental  worry,  hysteria,  over-exertion,  menstrual 
disorders,  dyspepsia,  puberty,  long  continued  use  of  tobacco, 
alcohol,  tea  and  cofTee ;  it  occurs  most  commonly  in  the 
female  sex. 

Symptoms. — There  may  be  present  and  felt  only  a  slight 
sensation  of  fluttering  of  the  heart ;  on  the  other  hand,  there 
may  be  hot  flushes,  forcible  pulsation  of  the  arteries,  the 
force  of  the  apex  beat  may  be  increased,  the  pulse  is  rapid, 
difficult  breathing,  and  nervousness.  The  attack  of  palpita- 
tion lasts  from  a  few  minutes  to  a  number  of  hours,  and  usually 
follows  mental  or  physical  exertion. 

Treatment. — Adjust  the  2nd  and  4th  dorsal  vertebrae;  for 
stimulation  of  the  vagus  to  inhibit  the  heart's  action,  concus- 
sion of  the  atlas  and  axis,  7th  cervical,  and  the  2nd  and  4th 
thoracic  vertebrae  is  necessary.  The  diet,  sleep  and  exercise 
of  the  patient  should  be  regulated.  Cold  sponge  baths  are 
very  useful. 


452  SPINAL  ADJUSTMENT 

Arrythmia 

Etiology. — The  primary  cause  of  this  disease  is  interference 
with  the  communicating  nerves  between  the  heart  and  its 
ganglia.  Contributing  causes  ^^re  reflex,  as  from  disease  of 
the  lungs,  stomach,  liver  or  kidneys ;  toxic,  as  the  use  of  drugs, 
tea,  coffee,  alcohol;  also  organic  disease  of  the  brain. 

Symptoms. — The  term  arrythmia  includes  either  irregu- 
larity in  the  action  of  the  heart  as  to  its  rhythm,  or  a  skipping 
of  heart  beats.  In  addition  to  the  symptoms  referable  to  the 
heart  itself,  there  will  be  present  also  those  of  the  underlying 
cause. 

Treatment. — The  treatment  of  this  disease  is  the  same  as 
that  of  palpitation  of  the  heart. 

Bradycardia 

Etiology. — The  primary  cause  of  this  disease  is  an  inter- 
ference with  the  conduction  of  the  nerve  impulses  which  gov- 
ern the  heart's  action.  Secondary  causes  are  other  organic 
nervous  diseases,  in  addition  to  which  it  also  accompanies 
fibroid  and  fatty  degeneration  of  the  heart,  and  hardening  of 
the  coronary  arteries.  It  is  also  seen  very  often  during  con- 
valescence from  such  diseases  as  diphtheria,  pneumonia, 
typhoid  fever,  rheumatism,  and  erysipelas. 

Symptoms. — Bradycardia  is  considered  to  be  present  when 
the  pulse  beats  have  been  diminished  in  number  to  40  per 
minute.  The  slow  heart  action  is  the  characteristic  symptom, 
and  the  pulse  is  accordingly  also  correspondingly  slow  in 
addition  to  which  it  is  thready.  The  first  sound  of  the  heart 
is  feeble,  and  indistinct,  and  the  second  sound  is  often  not 
heard  at  all.  Symptoms  which  are  present  as  a  result  of  a 
slow  heart  action,  are  attacks  of  fainting,  dizziness,  ringing  in 
the  ears,  and  sometimes  even  convulsions. 

Treatment.— Bradycardia  being  most  usually  simply  a 
symptom  of  some  other  condition,  the  underlying  cause 
should  be  determined,  and  proper  treatment  instituted.  As 
long  as  the  slowness  of  the  heart  action  does  not  interfere 
with  the  bodily  requirements,  no  special  treatment  is  indi- 
cated ;  if,  however,  the  opposite  obtains,  the  patient  should 
be  put  to  bed,  hot  compresses  applied  over  the  heart,  and  per- 
fect quiet  be  maintained. 


DISEASES  OF  CIRCULATORY  SYSTEM  453 

Tachycardia 

Etiology. — The  primary  cause  is  failure  of  the  inhibitory 
control  of  the  heart,  due  to  interference  with  the  vagus  nerve. 
Among  secondary  causes  may  be  mentioned  neurasthenia, 
chronic  indigestion,  continued  high  fever,  excessive  smoking, 
neuritis  of  the  pneumogastric  nerve,  and  the  menopause. 

Symptoms. — Preceding  the  attack  there  may  be  dizziness, 
ringing  in  the  ears,  and  a  foreboding.  The  attack  itself  comes 
on  very  suddenly,  and  the  heart  action  is  rapidly  increased  up 
to  200  beats  a  minute.  The  pulse  is  weak,  thready,  and  ir- 
regular. The  respiration  is  increased  in  frequency,  there  is 
difficult  breathing.  The  skin  is  pale,  but  later  becomes 
flushed.  A  smothering  sensation  is  present,  accompanied  by 
a  tight  feeling  about  the  heart.  Such  an  attack  lasts  from  a 
few  minutes  to  a  number  of  hours,  or  even  days. 

Treatment. — Adjust  the  1st  and  2nd  cervical,  and  the  2nd 
and  4th  dorsal  vertebrae.  Concussion  of  the  1st,  2nd  and  7th 
cervical  vertebrae.  Rest  in  bed  is  of  great  importance.  An 
ice  bag  should  be  applied  over  the  heart.  In  the  intervals  be- 
tween attacks  the  habits  should  be  regulated,  and  the  patient 
should  be  forbidden  to  use  any  harmful  substances  such  as 
tea.  coffee,  alcohol  and  tobacco. 

Arteriosclerosis 

Etiology. — The  primary  cause  of  this  affection  is  defective 
metabolism,  due  to  faulty  innervation,  as  the  result  of  which 
the  deposition  of  lime  salts  in  the  walls  of  the  arteries  is  per- 
mitted to  take  place ;  this  converts  the  arteries  from  soft  tubes 
into  very  hard  pipe-like  structures.  Secondary  causes  may 
be  worry,  physical  or  mental  over-exertion,  habitual  over- 
eating, chronic  poisoning,  as  by  gout,  syphilis,  tobacco,  alco- 
hol. Chronic  interstitial  Bright's  disease  is  also  a  very  com- 
mon cause  of  this  condition. 

Pathology. — The  degenerative  changes  in  the  vessels  may 
be  confined  to  a  certain  part  of  the  body,  or  be  general.  There 
is  an  overgrowth  of  the  tissues  of  the  middle  and  inner  coats 
of  the  vessel  walls.  In  advanced  cases  the  arteries  are  very 
hard,  thickened  and  tortuous. 

Symptoms. — These  are  not  always  evident,  and  differ  ac- 
cording to  the  arteries  involved.     When  the  sclerosis  of  the 


454  SPINAL  ADJUSTMENT 

arteries  is  general,  the  vessels  near  the  surface  of  the  body- 
have  a  hard,  bony  feel.  The  resistance  to  the  circulation  of 
the  blood  finally  results  in  enlargement  of  the  heart.  Sub- 
jective symptoms  present  are  dizziness,  spells  of  unconscious- 
ness, and  apoplectiform  seizures.  When  the  vessels  of  the 
kidneys  are  hardened,  Bright's  disease  develops.  When  the 
coronary  arteries,  or  the  aorta  are  hardened,  angina  pectoris 
and  myocarditis  develop. 

Treatment.- — General  adjustment,  especially  also  adjust- 
ment of  the  atlas,  4th  cervical,  5th  and  10th  dorsal,  and  2nd 
lumbar  vertebrae.  The  mode  of  life  must  be  regulated.  The 
bowels  and  kidneys  must  be  kept  active.  Avoidance  of  alco- 
hol, excesses  of  eating  or  drinking,  exertion,  excitement  or 
worry.  A  dry  diet  consisting  chiefly  of  vegetables,  is  to  be 
preferred.  A  moderate  amount  of  exercise  is  beneficial. 
Whenever  it  is  possible  to  do  so,  the  cause  of  the  sclerosis  of 
the  arteries  should  be  corrected. 

Aneurysm 

Etiology. — The  primary  cause  of  aneurysm  is  defective 
metabolism,  which  is  occasioned  by  an  impaired  action  of  the 
nerves,  due  to  interference  by  subluxations  of  the  vertebrae ; 
as  a  result  of  the  unbalanced  metabolism,  arteriosclerosis  de- 
velops, and  the  vessel  walls  become  weakened,  permitting  a 
portion  of  the  wall  to  become  pouched  out.  This  occurs  espe- 
cially after  hard  work,  or  sudden  exertion,  which  increases  the 
blood  pressure.  Among  the  most  common  secondary  causes 
may  be  mentioned  alcoholism  and  syphilis. 

Pathology. — The  vessel  walls  are  weakened  and  at  the 
point  of  weakening,  the  vessel  becomes  dilated. 

Symptoms. — There  are  two  main  varieties  of  aneurysm, 
which  are  of  importance,  namely,  aneurysm  of  the  thoracic 
aorta,  and  of  the  abdominal  aorta.  The  symptoms  of  an 
aneurysm  of  the  thoracic  aorta  are  a  pulsation  in  the  second 
and  third  intercostal  space  on  the  right  side ;  prominence  and 
enlargement  of  the  cutaneous  veins  over  the  seat  of  the 
aneurysm  ;  the  apex  beat  is  displaced ;  dullness  on  percussion ; 
the  pulse  in  the  radial  arteries,  is  unequal,  or  the  pulse  is  de- 
layed. As  a  result  of  the  pressure  of  the  aneurysm  upon  the 
trachea,  dyspnea,  pain,  cough,  hoarseness,  aphonia,  dysphagia 


DISEASES  OF  CIRCULATORY  SYSTEM  455 

may  develop.  The  symptoms  of  abdominal  aneurysm  are 
epigastric  pulsation,  abdominal  pain,  vomiting-,  and  une{iual 
occurrence  of  the  femoral  pulses.  This  form  of  aneurysm 
may  often  be  felt  with  the  hand. 

Treatment. — Adjustment  of  the  2nd  dorsal  vertebra  will 
diminish  the  pulsation  of  an  aneurysm  almost  at  once,  and  a 
course  of  adjustments  have  been  claimed  to  have  efifected  a 
cure.  Concussion  of  the  7th  cervical  vertebra  is  also  to  be 
used.  If  constipation  is  present,  fruits  should  be  eaten.  An 
Epsom  bath  every  second  day  is  a  helpful  measure.  If  the 
case  is  seen  early,  absolute  rest  in  bed  should  be  enforced, 
and  the  ingestion  of  fluids  limited  to  the  smallest  possible 
amount.  In  all,  cases  of  aneurysm  excitement  and  worry 
should  be  avoided,  and  the  use  of  stimulants,  and  over-exer- 
tion, are  forbidden. 

Varicose  Veins 

Etiology. — The  cause  of  this  condition  is  increased  intra- 
venous pressure  or  changes  in  the  vein  walls,  both  of  which 
are  primarily  due  to  disturbed  innervation,  as  a  result  of 
pressure  upon  the  nerves  which  control  the  area  involved. 

Symptoms. — The  symptoms  usually  complained  of  are  a 
feeling  of  fatigue,  and  a  sense  of  heaviness  of  the  limb,  after 
prolonged  standing  or  walking.  There  are  also  present  cold- 
ness of  the  feet,  edema  of  the  ankles,  and  a  numbness  of  the 
legs ;  sometimes  deep-seated  pain  is  present.  The  character- 
istic sign  of  varicose  veins  is  the  twisted,  enlarged  and  knotted 
veins  which  may  be  seen  upon  the  leg. 

Treatment. — Adjustment  in  the  lumbar  region.  Concus- 
sion of  the  7th  cervical  and  the  1st  and  2nd  lumbar  vertebrae: 
compresses  should  be  applied  on  the  leg  every  night.  Any- 
thing which  obstructs  the  circulation  must  be  removed,  for 
example,  tight  garters.  The  bowels  must  be  regulated,  and 
prolonged  standing  and  excessive  walking  should  be  avoided, 
although  a  certain  amount  of  exercise  is  very  beneficial  in 
these  cases.  If  the  condition  has  developed  very  suddenly, 
the  limb  must  be  rested  for  a  considerable  length  of  time, 
maintained  in  the  horizontal  position,  and  the  vein  protected 
from  any  strain  for  at  least  a  month.  The  general  health 
should  be  maintained  by  hygienic  measures. 


CHAPTER  VIII 

Diseases  of  the  Digestive  System 

Diseases  of  the  Mouth 
Catarrhal  Stomatitis 

Etiolog-y. — This  is  the  commonest  form  of  inflammation  of 
the  mouth  and  is  usually  due  to  various  irritants,  as  tobacco, 
acids,  hot  drinks,  etc.  It  is  seen  most  commonly  in  young 
children,  and  is  due  in  those  cases  to  delayed  dentition,  and 
also  infectious  fevers. 

Symptoms. — There  are  pain,  redness,  swelling  of  the 
mucous  membrane  of  the  mouth,  bad  breath,  a  slight  rise  in 
temperature,  and  retarded  secretion. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  dorsal 
vertebrae.  Remove  the  exciting  cause.  Regulate  the  diet. 
Swab  out  the  mouth  at  frequent  intervals  with  a  soft  piece 
of  absorbent  cotton  and  ice  water. 

Aphthous  Stomatitis  (Canker) 

Etiology. — This  form  of  inflammatioji  of  the  mouth  is  seen 
most  commonly  in  childhood,  and  is  due  to  delayed  dentition, 
eruptive  fevers,  indigestion  and  uncleanliness.  These  must 
be  considered  as  the  secondary  causes  of  the  disease,  while 
the  primary  cause  is  an  interference  with  the  conduction  of 
normal  nerve  impulses  to  the  mucous  membrane  of  the  mouth. 
Soon  after  the  disease  has  developed,  reflex  subluxations  are 
produced,  and  as  a  result  of  the  interference  with  the  nerve 
supply,  the  condition  becomes  aggravated,  and  may  develop 
into  the  ulcerative  or  gangrenous  type  in  some  cases. 

Pathology.— The  follicles  and  mucous  membrane  of  the 
mouth  and  tongue  are  first  inflamed ;  soon  small  reddish  spots 
form,  which  later  coalesce  to  form  large,  white  patches,  which 
later  rupture  and  leave  an  ulcer,  which  is  slow  in  healing. 

Symptoms. — The  chief  symptoms  of  this  disease  are  dys- 
phagia, pain,  slight  rise  in  temperature,  and  a  fetid  breath. 

456 


DISEASES  OF  DIGESTIVE  SYSTEM  457 

Treatment. — Adjust  the  4th  cervical  and  the  5th  and  7th 
thoracic  vertebrae.  Remove  the  exciting-  cause  if  possible. 
The  mouth  should  be  cleansed  after  each  feeding  in  the  case 
of  infants,  and  nursing  bottles  and  nipples  should  be  sterilized 
by  boiling. 

Ulcerative  Stomatitis 

Etiology. — This  disease  frequently  follows  the  aphthous 
form,  and  is  commonly  due  to  poor  hygienic  surroundings, 
and  an   insufficient  amount  of  proper  food. 

Pathology. — Small  ulcers  having  a  white  or  greyish  base, 
are  situated  most  commonly  on  the  gums. 

Symptoms. — The  gums  are  swollen,  bleed  easily,  and  are 
very  sensitive.  There  is  enlargement  of  the  submaxillary 
lymph  glands.  The  flow  of  saliva  is  markedly  increased,  the 
breath  is  fetid,  and  there  may  be  pronounced  constitutional 
symptoms. 

Treatment. — Adjust  the  4th  cervical  and  the  5th  dorsal 
vertebrae.  In  some  cases  the  ulcers  are  very  large  and  heal 
with  difficulty.  In  such  a  case  it  is  advisable  to  employ 
medicinal  measures. 

Gangrenous  Stomatitis  (Cancrum  Oris,  Noma,  Water  Cancer) 

Etiology. — This  disease  attacks  especially  children  of  low 
vitality,  brought  about  by  faulty  innervation.  The  direct 
cause  may  be  a  microorganism,  but  its  character  is  not  as  yet 
understood.  This  disease  is  seen  very  often  as  a  sequel  to 
typhoid  fever,  pneumonia,  scarlet  fever  and  measles. 

Symptoms. — The  disease  begins  very  suddenly.  A  necrotic 
spot  is  first  seen  on  the  inside  of  the  cheek,  which  spreads 
and  finally  causes  sloughing  of  a  great  portion  of  the  tissue, 
the  cheek  even  becoming  perforated  at  times.  The  tissue 
about  this  gangrenous  portion  is  hard  and  swollen.  There 
are  extreme  constitutional  symptoms. 

Treatment. — If  the  case  is  seen  early,  adjustment  of  the 
4th  cervical  and  the  5th  dorsal  vertebrae,  together  with  hot 
compresses  over  the  affected  side  of  the  face,  may  be  eflfective. 
Usually,  however,  the  condition  has  advanced  so  far  that  sur- 
gical measures  are  necessary. 


O 


458  SPINAL  ADJUSTMENT 

Parasitic  Stomatitis  (Thrush) 

Etiology. — The  direct  causes  of  this  disease  are  parasites. 
The  predisposing  causes  are  improper  food,  uncleanliness,  and 
a  low  grade  of  vital  resistance. 

Symptoms. — The  mouth  is  the  seat  of  small,  whitish  spots, 
which  are  usually  confined  to  the  tongue,  but  may,  however, 
involve  the  entire  mouth,  and  even  extend  to  the  larynx  and 
esophagus. 

Treatment. — Adjust  the  4th  cervical  and  5th  dorsal  verte- 
brae. Regulate  the  diet.  Keep  the  mouth  thoroughly 
cleansed. 

Mercurial  Stomatitis 

Etiology. — The  cause  of  this  condition  is  an  excessive 
amount  of  mercury  in  the  system.  Such  a  condition  may  be 
acquired  either  by  the  ingestion  of  an  excessive  amount  of 
mercury  for  medicinal  purposes,  and  in  those  whose  occupa- 
tion makes  it  necessary  for  them  to  work  with  mercury. 

Symptoms. — There  is  salivation,  sensitiveness  of  the  gums, 
fetid  breath,  a  metallic  taste,  and  marked  redness  of  the 
mucous  membrane  lining  the  oral  cavity.  If  the  case  is  ex- 
treme, the  maxillary  bones  may  become  necrotic  and  the  teeth 
fall  out. 

Treatment. — Adjust  the  4th  cervical  and  5th  thoracic  ver- 
tebrae. The  use  of  mercury  should  he  discontinued  im- 
mediately, or  the  patient's  occupation  be  changed,  as  the  case 
may  be.  Thorough  elimination  through  the  skin,  bowels  and 
kidneys  should  be  instituted  in  order  to  rid  the  system  of 
mercury  as  quickly  as  possible. 

Diseases  of  the  Stomach 

Acute   Gastritis 

Etiology. — The  primary  and  indirect  cause  of  Acute  Gas- 
tritis are  those  different  impaired  conditions  of  the  system  in 
general,  in  which,  as  a  result  of  faulty  innervation,  due  to  sub- 
luxation of  the  vertebrae,  the  functional  activity  of  the  stom- 
ach is  lessened  or  changed.  Predisposing  factors  to  acute 
gastritis  are  improper  hygienic  surroundings,  malnutrition, 
anemia,  and  adynamic  states.  It  is  seen  very  frequently  in 
tuberculosis,  cancer  and  malaria ;  also  in  sclerosis  of  the  liver 


DISEASES  OF  DIGESTIVE  SYSTEM  459 

and  various  cardiac  and  renal  diseases.  The  direct  and  ex- 
citing causes  are  chiefly  dietetic.  These  include  eating  too 
much  food,  food  of  an  improper  quality,  which  is  poisonous, 
or  too  highly  seasoned. 

Pathology. — The  lining  membrane  of  the  stomach  is  swol- 
len, congested,  and  covered  with  a  grayish,  tenacious  mucus. 
The  most  marked  inflammation  is  at  the  pyloric  end  of  the 
stomach.  In  cases  due  to  poisoning,  numerous  eroded  spots 
are  seen  upon  the  mucous  membrane,  and  destructive  changes 
may  be  present  in  the  mucous  and  muscular  coats. 

Symptoms. — The  symptoms  vary  in  accordance  with  the 
degree  of  the  inflammation.  In  severe  cases  there  may  be 
persistent  vomiting  of  a  greenish  fluid,  which  consists  of  a 
watery  substance  mixed  with  bile.  The  tongue  is  heavily 
coated,  the  breath  is  fetid,  there  is  intense  thirst,  a  moderate 
degree  of  fever,  pain  and  tenderness  in  the  epigastric  region. 
Headache  and  general  prostration  also  accompany  the  con- 
dition. 

Treatment. — Entire  abstinence  from  food  for  a  period  of 
from  24  to  48  hours.  Even  water  should  not  be  allowed,  and 
to  relieve  the  intense  thirst  which  is  present,  the  patient  may 
be  permitted  to  place  in  the  mouth  small  lumps  of  ice.  For 
the  pain  and  tenderness  over  the  epigastric  region,  hot  appli- 
cations should  be  used.  Rest  in  bed  is  also  indicated.  Adjust 
the  5th,  6th  and  7th  thoracic  vertebrae. 

Chronic  Gastritis 

Etiology. — This  is  usually  due  to  faulty  innervation  of  the 
stomach,  whereby  the  functional  activity  of  the  stomach  is 
markedly  impaired,  and  permits  the  contributing  factors  to 
still  further  aggravate  the  condition.  Among  the  contributing 
factors  are  especially  improper,  hasty,  and  irregular  and  ex- 
cessive eating.  In  addition  to  those  causes,  chronic  gastritis 
also  accompanies  other  diseases  of  the  stomach,  for  example : 
Cancer,  ulcer,  and  dilatation,  and  is  seen  in  diseases  of  the 
lungs,  especially  tuberculosis,  in  valvular  disease  of  the  heart, 
cirrhosis  of  the  liver,  Bright's  disease,  gout,  and  diabetes. 

Pathology. — The  stomach  is  usually  enlarged,  its  walls  are 
thickened,  and  there  is  an  excessive  secretion  of  mucus.  The 
mucous   membrane   lining   the   stomach   may   be   degenerated 


460  SPINAL  ADJUSTMENT 

and  erosions  be  present.  The  secretory  glands  of  the  stomach 
are  dilated  and  atrophic. 

Symptoms. — The  most  characteristic  symptoms  of  this 
disease  are  morning  nausea  and  vomiting  of  slimy  mucus. 
The  appetite  is  impaired,  the  tongue  is  covered  with  a  brown- 
ish coat,  there  is  a  bad  taste  in  the  mouth,  and  the  breath  is 
foul.  There  are  pains  and  an  oppressive  feeling  in  the  epigas- 
trium, after  meals,  and  vomiting  frequently  occurs  immedi- 
ately after  the  meal,  or  several  hours  thereafter.  Headache, 
nausea,  depression  and  melancholia  are  common  symptoms. 
Constipation  is  common.  The  motor  power,  secretory  and  ab- 
sorptive function  of  the  stomach  are  markedly  impaired. 

Treatment. — Adjust  the  5th,  6th  and  7th  thoracic  verte- 
brae. Adjustments  should  also  be  made  in  the  upper  cervical 
vertebrae,  for  their  influence  upon  the  vagus  nerves.  To  stim- 
ulate contraction  of  the  stomach,  concussion  of  the  spinous 
processes  of  the  2nd  dorsal  and  1st,  2nd  and  3rd  lumbar  verte- 
brae. In  all  cases  in  which  the  catarrhal  condition  of  the 
stomach  is  due  to  some  other  disease  process,  as,  for  example, 
Bright's  disease,  attention  should  be  given  to  such  causative 
factors.  Correct  the  diet,  and  instruct  the  patient  to  drink 
a  glass  of  hot  water  an  hour  before  breakfast  each  morning. 
Regulate  the  bowels.  Dilatation  of  the  rectum  is  a  very 
useful  measure.  Exercises,  especially  brisk  walking  in  the 
morning  are  very  useful  in  these  cases. 

Dilatation  of  the   Stomach 

Etiology." — The  direct  cause  of  dilatation  of  the  stomach 
is  interference  with  the  conduction  of  those  nerve  impulses 
whicli  are  essential  to  its  organic  integrity.  As  a  result  of  the 
withdrawal  of  these  impulses,  the  muscles  of  the  stomach  be- 
come flabby  and  weak,  and  enlargement  of  the  stomach  fol- 
lows. Contributing  causes  are  habitual  overeating,  a  narrowed 
condition  of  the  pyloric  orifice  from  tumors  or  following  an 
ulcer,  or  thickening  of  a  section  of  the  wall  at  that  point  in 
chronic  catarrh  of  the  stomach.  Weakness  of  the  muscular 
wall  of  the  stomach  also  occurs  in  wasting  diseases,  as 
tuberculosis,  cancer  and  anemia, 
appetite.     Loss  of  flesh  and  strength.    The  area  of  tympanitic 

Symptoms. — There  is  dull  pain  over  the  stomach.    Loss  of 


DISEASES  OF  DIGESTIVE  SYSTEM  461 

resonance  on  percussion  over  the  stomach  is  greatly  increased. 
Vomiting  occurs  several  hours  after  meals,  and  the  vomitus 
consists  of  a  large  amount  of  undigested  food.  The  motor, 
secretory  and  absorptive  powers  of  the  stomach  are  all 
deficient. 

Treatment. — Adjust  the  1st  and  2nd  cervical,  and  the  5th, 
6th  and  7th  dorsal  vertebrae.  For  producing  contraction  of 
the  stomach,  concussion  of  the  2nd  dorsal  and  the  1st,  2nd 
and  3rd  lumbar  vertebrae  are  recommended.  The  stomach 
should  be  thoroughly  washed  out  each  morning  with  a  solu- 
tion of  bicarbonate  of  soda  in  warm  water.  The  diet  should 
be  concentrated  and  dry,  liquids  being  reduced  to  a  minimum. 
Fat  and  starches  should  be  eliminated.  A  fast  of  a  day  or  two 
each  week  is  a  very  beneficial  measure  in  these  cases.  Rectal 
dilatation  is  a  very  useful  adjunct  in  the  treatment.  Hot 
bath^,  by  assisting  in  elimination  through  the  skin,  are  a  use- 
ful measure,  and  should  be  taken  about  three  times  a  week. 
Daily  exercise  in  the  open  air. 

Gastric  Ulcer 

Etiology. — Ulcers  of  the  stomach  are  due  to  a  disturbance 
of  the  nutrition  of  a  limited  section  of  the  mucous  lining  of 
the  stomach,  as  a  result  of  faulty  innervation  of  the  organ. 
This  section  of  the  stomach  is  then  subject  to  digestion  by 
the  gastric  juice,  which,  in  these  cases,  always  contains  an 
excessive  amount  of  acid.  Gastric  ulcer  is  seen  more  com- 
monly in  women  than  in  men,  and  between  the  ages  of  20  and 
30.  It  is  common  in  those  whose  occupation  requires  con- 
tinuous bending  forward,  such  as  tailors  and  shoemakers;  in 
these  people  the  intervertebral  foramina  of  the  mid-dorsal 
region  are  consequently  diminished  in  size,  on  account  of  the 
compression  of  the  intervertebral  discs,  and  as  a  result  of  the 
consequent  impingement  of  the  nerves  to  the  stomach,  which 
are  derived  from  this  region,  the  nutrition  of  the  lining  of 
the  stomach  suffers. 

Pathology. — A  typical  gastric  ulcer  is  usually  single,  and 
occurs  most  often  at  the  pyloric  end  of  the  stomach.  Such 
an  ulcer  is  usually  about  one-fourth  of  an  inch  in  diameter, 
its  edges  are  clean  cut,  and  its  floor  is  smooth.  Such  an  ulcer 
may  erode  into  a  blood  vessel  and  produce  hemorrhage.    Some- 


462  SPINAL  ADJUSTMENT 

times  the  ulcer  penetrates  the  entire  thickness  of  the  stomach 
wall,  and  perforation  of  the  stomach,  followed  by  peritonitis, 
results.  Stenosis  of  the  pyloric  orifice  frequently  follows  heal- 
ing of  the  ulcer,  and  dilatation  of  the  stomach  then  is  very 
apt  to  occur. 

Symptoms. — The  most  characteristic  symptoms  of  gastric 
ulcer  are  circumscribed  pain  and  tenderness,  which  the  patient 
indicates  by  pointing  with  the  finger  to  the  spot  afifected. 
Vomiting  is  common,  and  the  vomitus  may  contain  blood, 
although  it  is  more  common  to  find  blood  in  the  stools.  There 
is  distress  and  a  heavy  feeling  in  the  stomach,  soon  after 
eating,  and  vomiting  very  frequently  occurs.  The  pain  may 
occur  again  several  hours  after  eating,  and  is  then  produced 
by  the  passage  of  food  into  the  intestines  over  the  eroded 
lining  of  the  stomach  at  the  pyloric  orifice.  When  vomiting 
of  blood  occurs,  the  blood  is  usually  bright  red,  unless  it  has 
remained  in  the  stomach  for  some  time,  or  become  partially 
digested,  in  which  case  it  will  be  dark  brown.  Loss  of  flesh 
and  strength,  and  progressive  anemia,  are  common.  An 
excessive  amount  of  acid  in  the  gastric  juice  is  characteristic. 

Treatment. — Adjust  the  5th,  6th,  7th  and  10th  dorsal  ver- 
tebrae. Hot  compresses  over  the  stomach,  and  baths  every 
second  day  are  advisable.  For  hemorrhage,  concussion  of 
the  1st,  2nd  and  3rd  lumbar  and  the  2nd  dorsal  vertebrae  to 
produce  contraction  of  the  stomach  is  advisable.  An  ice  bag 
should  also  be  placed  over  the  stomach.  The  patient  should 
be  placed  in  bed  for  three  or  four  weeks ;  during  this  time 
the  diet  should  be  liquid,  and  if  even  this  is  not  tolerated  by 
the  patient,  rectal  feeding  must  be  instituted. 

Cancer  of  the  Stomach 

Etiology. — Cancer  usually  occurs  in  parts  which  have  been 
subjected  to  long  continued  irritation,  and  consequently  in  the 
stomach  it  occurs  very  commonly  in  those  who  have  suffered 
for  years  from  chronic  catarrh  of  the  stomach,  also  following 
gastric  ulcer,  or  trauma.  Family  predisposition  seems  to 
have  some  influence.  It  occurs  most  usually  in  persons  over 
40  years  of  age.  No  specific  cause  of  cancer  of  the  stomach  is 
known,  but  many  theories  have  been  advanced,  and  it  is  pos- 
sible that  defective  innervation  of  the  stomach  may  produce 


DISEASES  OF  DIGESTIVE  SYSTEM  463 

it  by  permitting  the  overgrowth  of  a  new  form  of  cells  to 
occur,  which  later  constitute  what  is  known  as  a  cancer. 

Pathology. — Several  varieties  of  cancer  occur  in  the  stom- 
ach, namely,  scirrhous,  colloid,  medullary  and  cylindrical  cells. 
The  cylindrical  cells  and  scirrhous  forms  usually  are  situated 
near  the  pylorus,  while  the  other  forms  are  scattered  through- 
out the  stomach.  When  the  growth  is  located  at  the  pyloric 
end  of  the  stomach,  obstruction  occurs  and  the  stomach  be- 
comes dilated ;  if,  however,  the  growth  is  situated  at  the  car- 
diac end  of  the  stomach,  that  orifice  is  constricted,  and  dilata- 
tion of  the  esophagus  takes  place. 

Symptoms. — The  first  symptoms  of  cancer  of  the  stomach 
are  usually  indigestion  for  a  short  time,  together  with  pro- 
gressive anemia,  and  a  gradual  loss  of  weight.  These  symp- 
toms are  followed  by  loss  of  appetite,  nausea  and  vomiting, 
an  hour  or  two  after  eating,  and  containing  blood  which  is 
partially  digested  and  black,  and  has  the  appearance  of  coffee 
grounds.  There  is  a  gnawing,  burning  pain  in  the  epigastric 
region,  back,  and  between  the  shoulders,  which  is  usually  in- 
creased by  taking  food.  Loss  of  flesh  and  strength  is  pro- 
gressive, secondary  anemia  develops,  and  finally  the  patient 
becomes  cachectic.  The  skin  is  pale,  yellowish  and  dry.  The 
tumor  can  often  be  felt,  and  is  nodular  and  freely  movable. 
Analysis  of  the  stomach  contents  shows  absence  of  hydro- 
chloric acid,  and  the  presence  of  lactic  acid. 

Treatment.- — The  prognosis  in  cancer  of  the  stomach  is 
generally  considered  to  be  decidedly  unfavorable.  Some 
Chiropractors  claim  to  be  able  to  cure  cancer  by  means  of 
spinal  adjustment,  if  the  case  is  seen  early,  but  admit  its 
hopelessness  if  the  case  is  at  all  advanced.  In  the  author's 
opinion,  the  only  respite  for  cancer  of  the  stomach  is  early  ex- 
cision, before  metastases  have  occured.  The  treatment  is 
otherwise  palliative ;  the  patient  should  eat  easily  digested 
food ;  the  stomach  should  be  washed  out  every  second  day 
and  supportive  measures  should  be  employed.  Adjust  the 
5th,  6th,  7th  and  10th  dorsal  vertebrae. 

Neuroses  of  the  Stomach  (Nervous  Dyspepsia) 

Etiology. — The  cause  of  the  various  forms  of  gastric 
neuroses  is  an  interference  with  the  conduction  of  those  nerve 


464  SPINAL  ADJUSTMENT 

impulses  which  are  essential  to  its  secretory  and  motor  activ- 
ity. The  stomach  requires  for  its  functional  activity  and  or- 
ganic integrity  a  continuous  and  uninterrupted  nerve-supply 
and  when  this  is  withdrawn  the  secretion  of  the  gastric  juices 
becomes  deficient,  motility  is  diminished,  and  various  dis- 
orders supervene. 

Symptoms. — Nervous  dyspepsia  manifests  itself  in  many 
different  ways,  chief  among  which  are  the  following:  1.  The 
Secretory  Neuroses  are  hyper-acidity,  namely,  an  excessive 
amount  of  secretion  of  hydrochloric  acid ;  sub-acidity,  which 
is  a  deficient  amount  of  hydrochloric  acid  in  the  gastric  juice. 

2.  The  Motor  Neuroses,  which  are  increased  motility ;  nervous 
eructations,  which  are  very  noisy,  and  the  gas  which  is  ex- 
pelled is  chiefly  air  which  has  been  previously  swallowed ; 
nervous  vomiting,  in  which  there  is  no  nausea  or  retching ; 
peristaltic  unrest,  in  which  the  patient  is  conscious  of  the 
movements  of  the  stomach ;  rumination,  which  is  the  regurgi- 
tation and  chewing  of  food ;  insufficiency  of  the  cardiac  or 
pyloric   orifices ;   spasms    of   the    cardiac    or   pyloric   orifices. 

3.  The  Sensory  Neuroses,  hyperesthesia,  in  which  various 
sensations  are  experienced  about  the  stomach,  during  diges- 
tion ;  gastralgia,  which  is  characterized  by  paroxysmal  pains 
about  the  stomach  and  radiating  to  the  back,  and  which  is 
relieved  by  taking  food ;  anorexia  nervosa  which  is  extreme 
dislike  for  food ;  akoria,  which  is  the  absence  of  sense  of  satis- 
faction following  eating ;  bulimia,  which  is  the  term  applied  to 
frequent  attacks  of  excessive  hunger. 

Treatment. — In  addition  to  the  general  nervous  basis, 
namely  hysterial  or  neurasthenic,  which  so  often  underlies 
the  gastric  neuroses,  and  which  require  general  adjustment 
and  massage  and  baths,  the  adjustment  of  the  specific  sub- 
luxation which  interferes  with  the  innervation  of  the  stomach 
should  be  attended  to ;  these  are  the  5th,  6th  and  7th  thoracic 
vertebrae.  In  addition  to  adjustment,  concussion  over  the 
spinous  processes  of  the  2nd  dorsal  and  the  1st,  2nd  and  3rd 
lumbar  vertebrae  is  also  necessary.  Rectal  dilatation  is  an 
important  and  very  useful  adjunct  measure  in  the  treatment 
of  cases  of  this  kind.  In  addition  to  these  measures,  the 
treatment  is  chiefly  symptomatic  and  should  be  directed  to 
the  correction  of  those  various  disorders  which  are  present. 


DISEASES  OF  DIGESTIVE  SYSTEM  465 

Diseases  of  the  Intestines 

Acute   Enteritis    (Inflammation  of  the   Bowels,   Acute   Diarrhea,   In- 
testinal Catarrh) 

Etiology. — The  most  common  causes  of  this  condition  are 
excessive  eating  and  drinking,  especially  of  improper  food, 
or  food  which  is  indigestible  or  decomposed ;  it  is  seen 
especially  during  the  summer  season,  and  follows  exposure 
to  cold  and  wet  while  perspiring.  The  disease  is  seen  very 
frequently  in  childhood,  and  follows  imperfect  hygiene  and 
the  presence  of  foreign  bodies  in  the  intestines. 

Pathology. — The  mucous  membrane  lining  the  intestinal 
canal  is  congested,  red,  swollen  and  edematous ;  later  there 
is  a  peeling  ofif  of  the  epithelium,  and  an  excessive  secretion ; 
as  a  result  of  the  extreme  congestion,  numerous  capillaries  in 
the  walls  of  the  intestines  rupture,  and  hemorrhages  ensue. 
The  glands  in  the  stomach  are  also  swollen  and  congested, 
and  have  a  tendency  to  ulcerate.  Such  a  process  may  involve 
only  sections  of  the  intestinal  tract,  or  the  entire  tract. 

Symptoms. — The  onset  is  sudden,  with  extreme  diarrhea, 
stools  being  watery  and  colic  being  present.  There  is  an  ex- 
cessive amount  of  gas  in  the  intestines,  extreme  thirst,  and 
symptoms  of  collapse  may  supervene. 

Treatment. — Adjust  the  11th  and  12th  dorsal  and  the  1st 
and  2nd  lumbar  vertebrae ;  the  patient  should  be  confined  in 
bed,  in  so  far  as  possible,  and  hot  compresses  be  applied  over 
the  abdomen.  The  diet  should  be  liquid,  although  with- 
drawal of  all  foods  is  preferable.  A  high  rectal  enema  should 
be  given  to  cleanse  the  bowels.  Rectal  dilatation  is  a  very 
useful  adjunct  measure.  Supportive  measures  should  be  em- 
ployed. 

Chronic  Enteritis 

Etiology. — This  disease  may  follow  the  acute  form.  It  is 
commonly  seen  in  chronic  diseases  such  as  Bright's  disease, 
tuberculosis,  malaria,  and  in  tubercular  or  cancerous  ulcers 
of  the  bowels.  It  often  results  from  the  chronic  congestion 
which  is  present  in  obstruction  of  the  portal  circulation  as 
seen  in  atrophic  cirrhosis  or  cancer  of  the  liver. 

Pathology. — The  mucous  membrane  of  the  intestine  is 
covered   with    stringy   mucus,   and   shows   hemorrhages   and 


466  SPINAL  ADJUSTMENT 

erosions.  The  sub-mucous  and  muscular  coats  of  the  intestines 
are  thickened,  the  glands  in  the  mucous  lining  are  atrophied, 
or  the  muscular  layer  may  be  also  atrophied,  in  which  case  the 
intestinal  wall  as  a  whole  will  be  very  much  thinned. 

Symptoms. — These  may  develop  gradually,  or  may  follow 
at  once  the  acute  form  of  Enteritis.  The  chief  symptom  is 
diarrhea,  with  or  without  colic,  alternating  with  constipation. 
When  the  large  bowel  is  chiefly  affected,  the  stools  are  thin 
and  watery  and  contain  a  large  amount  of  mucous.  When 
the  process  involves  chiefly  the  small  intestines,  portions  of 
undigested  foods  and  a  certain  amount  of  mucous  are  present 
in  the  stools.  The  abdomen  is  distended  with  gas.  There  is 
gradual  loss  of  weight  and  strength,  and  anemia  may  develop. 

Treatment. — Adjust  the  11th  and  12th  thoracic  and  the 
1st  and  2nd  lumbar  vertebrae.  Concussion  of  the  second  lum- 
bar vertebra.  Rectal  dilatation.  Hygienic  measures,  fresh  air, 
warm  clothing.  The  diet  should  consist  principally  of  milk 
for  several  weeks,  and  the  return  to  the  natural  diet  should 
be  very  gradual.  Hot  compresses  over  the  abdomen  are  use- 
ful in  cases  of  this  kind. 

Intestinal  Indigestion 

Etiology. — This  disease  is  a  functional  derangement,  due 
to  subluxations  in  the  lower  dorsal  and  upper  lumbar  region, 
which,  by  producing  impingement  upon  the  nerves  which 
govern  the  functional  activity  of  the  intestinal  tract,  result 
in  a  diminution  of  the  various  intestinal  secretions  and  de- 
ficient peristalsis  of  the  bowels.  As  a  result  of  the  deficiency 
in  the  digestive  juices  in  the  intestines,  and  also  deficient 
motility  of  the  bowels,  foods  are  left  undigested,  and  fermen- 
tation and  decomposition  result.  Other  direct  causes  may 
be  family  predisposition,  improper  diet,  or  improper  methods 
of  eating,  excessive  use  of  alcohol  and  tobacco,  mental  or 
physical  over-exertion,  and  diseases  of  the  stomach,  liver, 
kidneys,  and  pancreas.  These  different  conditions  may  all 
directly  operate  in  the  production  of  intestinal  indigestion, 
when  the  primary  causative  factor,  namely  disturbed  inner- 
vation, is  present. 

Symptoms. — This  disease  may  be  either  acute  or  chronic. 
The  acute  variety  is  usually  the  result  of  the  presence  of  some 


DISEASES  OF  DIGESTIVE  SYSTEM  467 

form  of  irritation  in  the  small  intestines,  the  characteristic 
symptoms  of  which  are  a  slight  rise  in  temperature,  anorexia, 
headache,  diarrhea,  coated  tongue,  and  tympanites.  In  more 
severe  attacks,  inflammation  may  also  exist,  which,  by  extend- 
ing into  the  bile  ducts,  causes  obstruction  to  the  outflow  of 
bile  into  the  intestines,  and  jaundice,  clay-colored  stools,  and 
highly-colored  urine  are  the  characteristic  symptoms  of  such 
a  condition.  Diarrhea  is  a  common  symptom,  the  stools  being 
at  first  normal,  and  later  becoming  thin  and  watery,  and  con- 
taining large  quantities  of  mucous. 

The  symptoms  of  the  chronic  form  are  pain  several  hours 
after  eating,  tenderness  of  the  abdomen,  tympanites,  and 
constipation.  As  the  disease  progresses,  anemia,  loss  of  flesh 
and  strength,  and  functional  disorders  of  the  liver,  together 
with  nervousness,  develop.  All  the  symptoms  of  malassimila- 
tion  later  develop. 

Treatment. — Adjust  the  11th  and  12th  dorsal,  and  the  1st 
and  2nd  lumbar  vertebrae.  In  the  acute  form  hot  magnesium 
sulphate  compresses  over  the  abdomen  should  be  applied.  In 
the  chronic  form  rectal  dilatation  is  one  of  the  most  valuable 
adjunct  measures  that  can  be  used.  The  diet  should  consist 
of  substances  which  are  bland  and  non-irritating,  and  easily 
digested,  and  fats  and  starches  should  be  especially  avoided. 
A  fast  of  three  days  is  indicated.  The  patient  should  take  a 
moderate  amount  of  exercise  in  the  open  air  every  day, 
although  not  to  the  point  of  producing  physical  exhaustion. 
When  the  disease  is  due  to  some  other  affection,  treatment 
should  be  directed  toward  the  relief  of  the  latter. 

Constipation    (Costiveness) 

Etiology. — The  primary  cause  of  this  disease  is  a  subluxa- 
tion of  the  lower  dorsal  or  upper  lumbar  vertebrae.  These 
spinal  lesions  produce  impingement  of  the  nerves  which  gov- 
ern the  intestines.  The  impingement  of  the  afferent  nerves 
prevents  the  conduction  of  those  impulses  from  the  bowel, 
which  excite  the  defecation  centers  to  action.  The  impinge- 
ment of  the  efferent  nerves  interferes  with  the  conduction  of 
those  motor  impulses  which  produce  the  movement  of  the 
intestines.  Many  cases  of  constipation  are  due  simply  to  the 
first  mentioned  cause,  namely  impingement  upon  the  afferent 


468  SPINAL  ADJUSTMENT 

nerves,  in  which  case  the  impulse  to  defecation  is  not  per- 
ceived by  the  patient.  When  in  addition  to  this  the  efferent 
nerves  are  also  impinged,  the  motor  impulses  which  excite 
the  bowels  to  action,  never  reach  the  walls  of  the  intestines. 
When  the  primary  cause  of  constipation  is  present,  the  con- 
tributing factors,  the  product  of  the  disease,  aggravate  the 
condition,  which  would  be  impossible,  were  the  innervation 
of  the  bowels  perfect.  The  secondary  causes  of  constipation 
are  a  sedentary  occupation,  individual  peculiarity,  improper 
diet,  and  drugs.  The  disease  also  accompanies  many  other 
conditions. 

Symptoms. — No  special  symptoms  may  be  present, 
although  any  of  the  following  signs  of  constipation  may  be 
met  with :  Headache,  which  is  made  worse  by  moving  the 
head,  intercurrent  attacks  of  diarrhea,  indigestion,  dizziness, 
skin  eruptions,  and  malaise. 

Treatment. — Adjustments  should  be  made  of  the  11th  and 
12th  dorsal,  and  the  1st  and  2nd  lumbar  vertebrae;  a  complete 
spinal  analysis  should,  however,  be  made,  and  adjustments 
made  of  subluxated  vertebrae  wherever  they  exist.  The  next 
important  measure  is  to  regulate  the  habits  of  the  patient ; 
many  persons  from  motives  of  pride,  or  inability  to  move  the 
bowels  at  a  certain  time,  so  derange  this  function  that  con- 
stipation results ;  a  regular  time  should  therefore  be  had  for 
attending  to  this  function.  Next  in  importance  comes  regu- 
lation of  the  diet,  which  in  these  cases  should  be  meat-free, 
and  consist  of  substances  which  are,  in  the  main,  laxative. 
Abdominal  massage  is  a  very  important  measure  in  these 
cases,  in  addition  to  which  certain  well  regulated  exercises 
should  be  taken.  Rectal  dilatation  is  a  very  valuable  adjunct 
measure. 

Diarrhea 

Etiology. — The  cause  of  this  condition  is  principally  dis- 
turbed innervation  to  the  intestines  producing  organic  and 
functional  derangements  therein.  Contributing  causes  are 
indigestion,  improper  food,  and  intestinal  inflammation. 
Diarrhea  also  follows  sudden  changes  in  temperature,  mental 
shocks,  infectious  fevers,  and  occurs  in  wasting  diseases,  such 
as  tuberculosis,  cancer,  diabetes,  etc. 


DISEASES  OF  DIGESTIVE  SYSTEM  469 

Symptoms. — Diarrhea  may  be  present  in  two  forms,  first, 
the  acute,  and  second,  the  chronic.  The  acute  form  of 
diarrhea  may  be  of  several  varieties.  For  instance,  (a)  the 
bilious  form  which  is  caused  by  excessive  bile  in  the  bowels, 
and  the  symptoms  of  which  are  colic,  burning  of  the  anus,  the 
stools  being  yellow  or  greenish,  (b)  The  feculent  form,  which 
is  the  result  of  errors  in  diet,  intestinal  parasites,  and  indiges- 
tion, and  the  symptoms  of  which  are  colic  after  meals,  nausea, 
a  desire  for  stool,  and  gas.  Stools  are  very  offensive,  and  are 
fluid,  (c)  The  lienteric  form,  in  which  the  food  passes  through 
entirely  undigested.  In  addition  to  the  stools  containing  this 
undigested  food,  they  also  contain  mucus  and  bile.  The 
chronic  form  is  also  classified  according  to  the  nature  of  the 
stools.  There  are  thus  mucous  stools,  watery  and  serous 
stools,  lienteric  stools,  black  stools,  red  stools,  bloody  stools 
and  green  stools. 

Treatment. — Adjust  the  10th  and  11th  thoracic,  and  the 
2nd  lumbar  vertebrae,  for  their  influence  upon  the  condition. 
Subluxations  in  these  regions  impinge  the  nerves  which  gov- 
ern the  action  of  the  bowels.  If  necessary,  also  adjust  the 
5th  dorsal  vertebra  for  its  influence  upon  the  stomach  and  the 
10th  dorsal  vertebra  when  the  kidneys  are  inactive.  One  of 
the  most  valuable  adjunct  measures  of  treatment  is  rectal 
dilatation,  which  should  be  used  in  these  cases.  In  acute  cases 
of  diarrhea  all  food  should  be  withdrawn  for  a  few  days;  in 
the  chronic  variety  the  diet  should  be  made  up  of  substances 
which  are  easily  digestible.  In  the  acute  form,  rest  in  bed 
and  daily  magnesium  sulphate  (hot)  baths  are  indicated. 

Cholera   Morbus 

Etiology. — This  disease  is  seen  most  commonly  during 
the  summer  and  autumn  months,  and  is  brought  about  by 
sudden  atmospheric  chang-es,  and  the  presence  of  irritants  in 
the  intestinal  tract,  caused  by  the  eating  of  unripe  fruits, 
vegetables,  or  the  presence  of  decomposed  foods. 

Symptoms. — The  disease  commences  suddenly,  with  a 
chill,  nausea  and  vomiting,  and  diarrhea,  with  intense  intes- 
tinal colic.  The  vomitus  first  consists  of  the  ordinary  stom- 
ach contents,  and  later  is  made  up  of  bile,  and  finally  water. 
The  stools  at   first  consist  of  normal  feces,  later  becoming 


470  SPINAL  ADJUSTMENT 

green,  and  finally  white,  resembling  rice-water.  Great  pros- 
tration is  present.  There  is  intense  thirst.  Rapid  loss  of 
strength  and  flesh  supervene. 

Treatment. — Adjust  the  5th,  6th,  7th,  11th  and  12th  dor- 
sal, and  the  1st  lumbar  vertebrae.  Concussion  of  the  11th 
dorsal  vertebra  is  very  useful  in  causing  relaxation  of  the 
muscular  coat  of  the  bowels,  and  thus  influencing  the  colic. 
Hot  compresses  over  the  abdomen  are  very  beneficial.  To 
relieve  the  extreme  thirst,  let  the  patient  dissolve  small  pieces 
of  ice  in  the  mouth,  but  he  should  not  be  permitted  to  swallow 
the  water. 

Intestinal  Obstruction 

Etiology.- — Intussusception  or  telescoping  of  the  bowels ; 
volvulus  or  twisting  of  the  bowels ;  cancer  of  the  wall  of  the 
intestines ;  stricture  of  the  intestines ;  foreign  bodies  in  the 
intestines ;  adhesions ;  tumors  of  neighboring  organs  pressing 
upon  the  intestines;  strangulated  hernia. 

Symptoms. — The  characteristic  symptom  of  this  condition 
is  complete  constipation  although  there  may  be  passage  of  a 
slight  amount  of  mucus  and  blood.  Vomiting  is  an  early 
symptom,  the  vomitus  first  consisting  of  stomach  contents, 
then  of  partially  digested  food,  and  finally  becoming  fecal. 
There  is  great  prostration.  Severe  pain  is  present  in  the  ab- 
domen, and  after  peritonitis  has  developed,  as  it  usually  does, 
marked  tenderness  is  present.  When  the  obstruction  is  in 
the  small  intestines,  the  umbilical  region  is  distended ;  when 
the  obstruction  is  in  the  large  intestines,  the  iliac  regions  are 
distended.  When  the  obstruction  is  due  to  impaction  of  feces 
in  the  rectum,  or  to  new  growths  in  this  location,  palpation 
will  reveal  the  condition. 

Treatment. — When  the  obstruction  is  situated  in  the  small 
intestines,  adjust  the  11th  and  12th  thoracic  vertebrae.  When 
the  large  bowel  is  the  seat  of  the  obstruction,  adjust  the  1st 
and  2nd  lumbar  vertebrae.  Concussion  of  the  11th  thoracic 
vertebra  may  relieve  the  condition  if  it  is  due  to  spasmodic 
contraction  of  the  bowels,  for  the  reason  that  concussion 
over  the  spinous  process  of  the  11th  thoracic  vertebra,  pro- 
duces relaxation  of  the  muscular  coat  of  the  bowel.  Should 
these  measures  be  unproductive  of  results,  surgical  interfer- 
ence becomes  necessary. 


DISEASES  OF  DIGESTIVE  SYSTEM  471 

Enteroptosis  (Falling  of  the  Viscera) 

Etiology. — Downward  displacement  of  the  stomach  and 
intestines,  together  with  the  liver,  spleen  and  kidneys ;  it  is 
seen  most  commonly  in  women  who  are  of  a  highly  nervous 
temperament.  It  often  accompanies  wasting  diseases,  in  which 
there  is  a  great  loss  of  flesh.  It  is  also  due  to  weakness  of 
the  support  of  these  organs,  and  weakness  of  the  abdominal 
walls.  The  failure  of  the  support  of  the  organs  to  hold  them 
in  their  proper  position  is  due  to  the  interference  with  the 
conduction  of  those  constant  impulses  which  maintain  the 
muscles  in  a  state  of  slight,  permanent  contraction.  When 
subluxations  occur  in  certain  sections  of  the  spine,  and  inter- 
fere with  the  conduction  of  these  necessary  nerve  impidses, 
relaxation  of  the  ligaments  and  other  supports  of  the  internal 
organs  occurs,  and  falling  of  the  viscera  ensues. 

Symptoms. — No  special  symptoms  may  be  present, 
although  patients  frequently  complain  of  headache,  indiges- 
tion, dragging  pain  in  the  back,  and  a  constant  tired  feeling, 
all  of  which  are  dependent  upon  the  nervous  basis  underlying 
the  condition.  The  displaced  organs  can  readily  be  palpated. 
Constipation  is  also  a  common  symptom.  The  abdomen  is 
distended. 

Treatment. — After  a  careful  examination  of  the  abdominal 
viscera  has  determined  the  organs  which  are  affected,  and  a 
spinal  analysis  has  shown  the  location  of  the  lesion,  the  proper 
adjustment  should  be  made,  and  in  many  cases  this  restora- 
tion of  the  nerve  impulses  to  the  affected  parts  will  greatly 
assist  in  the  production  of  a  cure.  When  the  enteroptosis  is 
due  to  a  previous  wasting  disease,  a  diet  designed  for  fatten- 
ing the  patient  should  be  prescribed.  In  neurasthenic  indi- 
viduals, hygienic  and  other  measures  should  be  employed. 
Use  a  firm  abdominal  binder  in  those  in  whom  it  is  deemed 

advisable. 

Intestinal  Colic   (Enteralgia) 

Etiology. — This  condition  is  more  in  the  nature  of  a  symp- 
tom than  a  specific  disease,  and  is  seen  in  persons  of  a 
neurotic  temperament,  being  also  predisposed  to  by  general 
debility,  mental  overwork  or  worry,  and  chronic  gastro-intes- 
tinal  diseases.  The  direct  causes  are  exposure  to  cold  and 
damp,  and  the  presence  of  some  irritation  in  the  bowels.     It 


472  SPINAL  ADJUSTMENT 

is  also  a  frequent  accompaniment  of  cerebro-spinal  diseases, 
locomotor  ataxia,  and  hysteria. 

Symptoms. — The  most  characteristic  symptom  is  spas- 
modic pain  referred  to  the  umbilical  region,  and  migrating 
from  one  section  of  the  abdomen  to  another;  this  pain  may 
be  either  sharp  or  dull,  and  is  relieved  by  pressure.  There 
is  cold  perspiration,  the  face  is  pale,  and  there  are  symptoms 
of  prostration.  The  passage  of  gas  or  feces  usually  terminates 
the  condition. 

Treatment. — Adjust  the  10th  to  12th  thoracic  and  the  1st 
and  2nd  lumbar  vertebrae.  Concussion  of  the  11th  thoracic 
vertebra  should  be  used  for  its  relaxing  effects  upon  the 
musculature  of  the  bowels.  For  the  relief  of  the  colic,  the 
application  of  hot  compresses  over  the  abdomen  is  very  use- 
ful.    In  all  cases  the  cause  of  the  intestinal  colic  should  be 

corrected. 

Mucous  Colitis 

Etiology. — This  disease  is  seen  most  commonly  in  women 
who  are  of  a  neurotic  type,  or  hysterical.  Causes  which  may 
operate  in  producing  an  attack  are  dyspepsia,  indigestion  of 
improper  foods,  and  various  emotions. 

Symptoms. — This  condition  is  chronic.  There  are  period- 
ical attacks,  abdominal  pain  and  tenderness,  and  the  passage 
from  the  bowel  of  mucous  casts.  A  great  variety  of  nervous 
symptoms  exist.     Constipation  is  a  prominent  symptom. 

Treatment. — Adjust  the  12th  dorsal  and  2nd  lumbar  ver- 
tebrae. Give  an  enema  of  salt  solution  every  day.  Attend 
to  the  general  health  of  the  patient. 

Appendicitis 

Etiology. — The  primary  cause  of  appendicitis  is  an  inter- 
ference with  the  conduction  of  the  normal  nerve  impulses  to 
the  appendix.  The  low  grade  of  resistance  which  then  ob- 
tains in  the  appendix  permits  of  the  inflammation  which  is 
produced  by  the  various  contributing  causes, ,  chief  among 
which  are  the  fact  that  the  appendix  is  not  drained  very 
readily,  and  consequently  extension  to  it  of  an  inflammation 
of  the  bowels  readily  closes  its  lumen,  and  any  substances 
which  may  be  imprisoned  within  the  appendix,  together  with 
bacteria  which  are  constantly  present  in  the  bowels,  excite 


DISEASES  OF  DIGESTIVE  SYSTEM  473 

an  inflammatory  process  therein.  It  is  seen  most  commonly 
in  young  adult  males.  It  may  also  follow  typhoid  fever, 
grippe  and  tuberculosis,  or  it  may  be  a  result  of  twisting  of 
the  appendix  itself. 

Pathology. — In  simple  cases  there  is  merely  a  catarrhal 
inflammation  of  the  appendix.  This  may  go  no  further  and 
recovery  ensue.  In  some  cases,  however,  there  appears  to 
be  a  marked  tendency  towards  ulceration,  especially  when  the 
innervation  of  the  appendix  is  practically  nil.  In  still  other 
cases  the  appendix  rapidly  become  gangrenous  and  perfora- 
tion follows. 

Symptoms. — The  onset  is  usually  very  sudden,  and  gener- 
ally occurs  after  eating  a  full  meal.  The  first  symptoms  are 
nausea  and  vomiting;  this  is  followed  by  a  rapid  rise  in  tem- 
perature, and  severe  pain,  which  is  at  first  diffused  over  the 
entire  abdomen,  but  later  becomes  localized  to  McBurney's 
point.  Rigidity  of  the  muscles  in  the  right  iliac  region  is 
present,  and  there  is  tenderness  on  light  pressure  over  the 
appendix. 

Treatment. — In  all  cases  of  appendicitis  it  will  be  found 
that  the  2nd  lumbar  vertebra  is  subluxated,  and  adjustment 
should  be  therefore  made  at  this  point.  In  many  cases  this 
will  alone  be  sufficient  to  limit  the  disease.  Accessory 
methods  of  treatment  which  are  advisable  to  use,  are  with- 
drawal of  all  food,  rest  in  bed,  hot  compresses  over  the  right 
iliac  region,  and  enemas  of  salt  solution.  In  those  cases  in 
which  the  disease  is  due  to  a  twisting  of  the  appendix  or  to 
the  presence  within  it  of  a  foreign  substance,  concussion  of 
the  11th  dorsal  vertebra  by  relaxing  the  musculature  of  the 
bowel,  sometimes  proves  to  be  of  great  assistance  in  such 
instances.  Rectal  dilatation  also  is  an  invaluable  adjunct 
measure  of  treatment. 

If  these  measures  fail  to  give  relief,  and  it  is  evident  that 
suppuration  has  taken  place,  surgical  measures  will  have  to 
be  adopted. 

Diseases  of  the  Liver,  Gall  Bladder  and  Bile  Passages 

Congestion  of  the  Liver  (Torpid  Liver,  Biliousness) 

Etiology. — Congestion  of  the  liver  occurs  in  two  forms : 
First,  the  passive  form  which  is  due  to  diseases  of  the  heart 


474  SPINAL  ADJUSTMENT 

and  lungs;  second,  the  active  form,  which  is  due  to  chronic 
constipation,  excesses  in  eating-  and  drinking,  especially  of 
highly  seasoned  foods  and  alcoholic  beverages.  If,  in  the 
presence  of  these  contributing  causes  the  innervation  of  the 
liver  is  impaired,  congestion  will  be  certain  to  take  place. 

Pathology. — The  liver  is  uniformly  enlarged ;  its  surface 
is  smooth,  and  the  free  border  is  harder  than  normal,  but 
smooth. 

Symptoms. — There  are  pain  and  an  uncomfortable  feeling 
in  the  region  of  the  liver,  gastro-intestinal  disturbances,  and 
sometimes  jaundice.  Occasionally  there  is  vomiting  of  blood, 
and  dropsy.  There  may  be  a  slight  bulging  of  the  hypochon- 
driac region,  and  pulsation  of  the  liver  may  be  seen.  On  per- 
cussion it  is  found  that  the  area  of  liver  dullness  is  increased. 

Treatment. — Adjust  the  4th  and  5th  dorsal  vertebrae,  and 
also  determine  the  presence  of  subluxations  in  the  7th  to  10th 
dorsals  and  adjust  same.  Concussion  of  the  7th  cervical  to 
6th  thoracic  region  should  be  used  for  its  vaso-constrictor 
effect.  For  further  constriction  of  the  liver,  concussion  of 
the  1st  and  2nd  lumbar  vertebrae  is  to  be  used.  Apply  hot 
compresses  over  the  liver,  and  give  hot  magnesium  sulphate 
baths  every  second  day.  Give  an  enema  of  salt  solution  each 
day.  The  diet  should  be  corrected  and  a  fast  of  a  day  or  two 
at  the  onset  of  the  disorder  is  followed  by  good  results. 

Fatty   Liver 

Etiology. — The  primary  cause  of  this  disease  is  faulty  in- 
nervation, which  causes  a  disturbance  in  the  balanced  meta- 
bolism, and  thus  permits  of  the  accumulation  of  fats  in  the 
liver.  Contributing  causes  are  general  obesity,  and  an 
adynamic  state  due  to  tuberculosis,  cancer,  or  other  wasting 
diseases ;  lastly,  severe  anemia,  prolonged  use  of  alcohol,  and 
phosphorus  poisoning,  all  of  which  produce  imperfect  oxida- 
tion of  the  blood. 

Pathology. — The  liver  is  uniformly  enlarged,  and  the  en- 
largement often  extends  as  far  as  the  umbilicus.  The  surface 
of  the  liver  is  smooth,  its  edge  is  smooth  and  rounded  and 
soft. 

Symptoms. — Symptoms  are  usually  absent.  There  may, 
however,  be  tenderness  and  pain  in  the  hepatic  region  from 


DISEASES  OF  DIGESTIVE  SYSTEM  475 

the  dragging  weight  of  the  enlarged  organ,  jaundice  is  rare, 
and  dropsy  never  occurs  in  this  condition. 

Treatment. — This  should  be  directed  first  of  all  to  the 
general  obesity  which  is  usually  present,  by  adjustment  of 
4th,  6th  and  10th  dorsal  vertebrae.  ■  In  addition  to  these  ad- 
justments, the  segments  controlling  the  liver  should  also  be 
examined,  and  adjustment  of  the  7th  dorsal  vertebra  be  made. 
The  diet  should  contain  a  minimum  amount  of  fats  and  carbo- 
hydrates. Hot  baths  daily  at  bed-time  are  very  useful.  The 
contributing  causes  should  also  be  corrected. 

Waxy    Liver    (Amyloid   Liver) 

Etiology. — Waxy  degeneration  of  the  liver  is  seen  most 
commonly  in  diseases  attended  by  chronic  suppuration, 
especially  of  the  bones.  It  is  also  seen  in  connection  with 
similar  degeneration  in  the  spleen  and  kidneys.  It  occurs 
also  in  connection  with  some  infectious  diseases,  and  in 
wasting  diseases,  in  cancer,  tuberculosis  and  syphilis.  The 
reason  that  the  liver  becomes  involved  in  the  above  men- 
tioned conditions,  is  probably  due  to  the  fact  that  reflex  sub- 
luxations are  produced  in  segments  of  the  spine  which  control 
several  organs.  These  spinal  lesions,  by  interfering  with  the 
conduction  of  the  normal  amount  of  nerve  impulses  to  the 
liver,  render  it  more  susceptible  to  involvement  by  the  same 
process  which  is  aflfecting  such  other  organs. 

Pathology. — The  liver  is  uniformly  enlarged,  its  border  is 
smooth  and  firmer  than  normal.  The  enlargement  is  extreme, 
and  jaundice  and  dropsy  appear  late  in  the  course  of  the 
disease. 

Symptoms. — The  enlargement  of  the  liver  is  the  only 
characteristic  sign.  On  percussion  the  area  of  liver  dullness 
is  shown  to  be  markedly  increased.  There  is  no  pain.  The 
enlargement  of  the  spleen  and  kidneys,  in  connection  with 
the  enlargement  of  the  liver,  is  diagnostic.  Gastro-intestinal 
disturbances  and  loss  of  flesh  and  strength  later  occur. 

Treatment.— Adjust  the  4th,  5th,  7th  and  10th  dorsal  ver- 
tebrae. Concussion  of  the  11th  and  12th  thoracic  vertebrae 
should  be  used  for  its  vaso-dilatory  efifect  upon  the  vessels  of 
the -liver.  Daily  hot  baths,  and  compresses  over  the  liver 
should  be  used.    If  necessary,  the  area  in  which  a  suppurative 


476  SPINAL  ADJUSTMENT 

process   is  existing,   should  receive  surgical   attention.     The 
underlying  cause  should  be  corrected  in  as  far  as  possible. 

Cysts  of  the  Liver 

Etiology. — The  cause  of  a  cystic  condition  of  the  liver  has 
been  mentioned  under  the  head  of  diseases  due  to  animal 
parasites,  being  caused  by  intestinal  parasites,  the  tenia 
echinococcus,  contracted  most  commonly  from  the  dog.  It  is 
rare  in  this  country,  but  is  quite  common  in  localities  where 
conditions  make  necessary  constant  use  of  dogs  by- man.  The 
eggs  are  ingested  by  man,  and  on  being  digested  in  the  stom- 
ach and  intestines,  the  liberated  embryos  find  their  way  into 
the  portal  circulation,  and  thus  reach  the  liver.  They  become 
lodged  there  and  form  the  cysts. 

Pathology. — The  wall  of  the  cysts  consist  of  two  layers, 
the  inner  layer  being  the  one  from  which  daughter  cysts  are 
formed.  The  irritation  which  is  occasioned  by  the  presence 
of  these  cysts,  causes  a  capsule  of  connective  tissue  to  be 
formed  about  them.  Within  the  capsule  is  present  a  clear 
fluid.  The  parasite  later  dies,  but  the  cyst  grows  slowly,  and 
may  later  be  dried  up,  or  calcified,  or  changed  into  an  abscess. 

Symptoms. — The  liver  is  enlarged  in  certain  sections,  and 
if  the  cyst  is  located  on  the  under  surface  of  the  liver,  it  may 
be  palpated  as  a  round,  fluctuating  mass.  If  it  is  situated  on 
the  upper  surface  of  the  liver,  it  points  into  the  pleural  sac, 
and  may  in  such  cases  resemble  pleurisy  with  effusion.  To 
differentiate  these  two  conditions  it  must  be  remembered  that 
the  line  of  flatness  in  pleurisy  with  efifusion  is  perfectly  hori- 
zontal, while  in  cysts  of  the  liver  the  upper  line  of  flatness  is 
curved.  Jaundice  sometimes  occurs;  dyspnea  by  pre- sure  on 
the  lungs  is  sometimes  present,  as  well  as  fever  and  pain. 

Treatment. — Adjust  the  4th,  5th  and  7th  dorsal  vertebrae. 
Apply  hot  compresses  over  the  liver,  and  give  hot  baths  every 
other  day.  Concussion  over  the  1st  and  2nd  thoracic,  and  the 
1st  and  2nd  lumbar  vertebrae.  In  some  cases  surgical  meas- 
ures are  necessary. 

Abscess  of  the  Liver 

Etiology. — The  primary  cause  of  abscesses  of  the  liver  is 
faulty  innervation  of  that  organ,  with  a  consequent  diminu- 


DISEASES  OF  DIGESTIVE  SYSTEM  477 

tion  in  its  vital  resistance.  In  the  presence  of  such  a  condi- 
tion, the  contributing  causes,  namely  trauma,  dysentery, 
typhoid  fever,  pelvic  abscesses,  and  intestinal  ulcers,  in  which 
the  affected  medium  reaches  the  liver,  via  the  portal  circula- 
tion, produce  abscesses  in  the  liver.  Abscesses  of  the  liver 
in  such  cases  are  always  multiple.  Single  abscess  of  the  liver 
usually  occurs  in  tropical  countries,  following  dysentery,  and 
the  colon  bacillus  is  the  direct  cause. 

Pathology. — The  liver  is  irregularly  enlarged,  and  if  the 
abscesses  are  near  the  surface  they  may  be  palpated  as  round, 
fluctuating  masses. 

Symptoms. — The  characteristic  sign  of  abscess  of  the  liver 
is  the  enlargement  of  that  organ.  Tenderness  is  always  pres- 
ent, and  a  dragging  pain  which  is  referred  to  the  right  shoul- 
der is  complained  of.  Jaundice  usually  occurs.  Slight  fever 
may  be  present,  or  it  may  be  more  of  the  septic  type,  namely, 
alternating  with  chills. 

Treatment. — Adjustment  of  the  4th  to  8th  thoracic  ver- 
tebrae early  in  the  condition  may  have  a  favorable  influence 
upon  it.  Concussion  of  the  1st  and  2nd  dorsal,  and  the  1st 
and  2nd  lumbar  vertebrae,  for  their  vaso-dilatory  effect  upon 
the  vessels  of  the  liver,  may  help ;  in  this  way  an  increased 
amount  of  blood  is  drawn  toward  the  liver,  which  may  over- 
come the  infective  process.  Hot  Epsom  salt  compresses 
should  be  kept  constantly  applied  over  the  hepatic  region. 
Daily  enemas  should  be  given,  for  the  purpose  of  keeping 
the  intestinal  tract  thoroughly  cleansed.  Close  and  constant 
observation  of  the  patient  is  necessary  at  all  times,  as  surgical 
interference  may  become  necessary. 

Cancer  of   the   Liver 

Etiology. — This  disease  usually  occurs  most  commonly  in 
men  at  the  age  of  40  to  60  years ;  heredity  seems  to  have  some 
influence ;  there  are  various  kinds  of  irritation,  including 
trauma  which  may  also  be  considered  as  etiological  factors. 
It  is  rarely  primary.  Usually  it  is  secondary  to  cancer  in 
other  organs  or  parts  of  the  body,  especially  the  intestines, 
stomach,  pancreas,  or  gall  bladder. 

Pathology. — The  liver  is  greatly  increased  in  size,  in  fact, 
cancer  of  the  liver  causes  greater  enlargement  in  size  than 


478  SPINAL  ADJUSTMENT 

any  other  condition.  The  edge  of  the  liver  is  nodular,  and  the 
nodules  are  harder  than  the  surrounding  liver  substance,  and 
are  also  very  tender.  The  surface  of  the  liver  is  also  nodular. 
Jaundice  is  present,  and  later  in  the  course  of  the  disease, 
ascites  develops. 

Symptoms. — Various  gastro-intestinal  symptoms  precede 
the  actual  development  of  carcinoma  of  the  liver.  Later  on, 
however,  pain  and  distress  in  the  abdomen,  together  with  a 
feeling  of  weight,  are  noticed  by  the  patient.  Jaundice  and 
dropsy  next  occur,  and  the  symptoms  of  cachexia  develop. 
There  is  no  fever  unless  there  are  complications  toward  the 
end  of  the  disease.  Palpation  elicits  tenderness,  and  the  per- 
cussion note  of  dulness  is  increased. 

Treatment.- — Make  adjustments  in  the  mid-dorsal  region. 
Otherwise  the  treatment  is  symptomatic. 

Acute  Yellow  Atrophy 

Etiology. — This  disease  occurs  most  commonly  in  young 
women  between  the  ages  of  20  and  30,  during  pregnancy.  The 
real  cause  is  uncertain,  but  it  seems  to  be  some  form  of  poison 
circulating  in  the  blood. 

Pathology.— The  liver  is  greatly  decreased  in  size,  and 
its  capsule  is  wrinkled.  The  liver  cells  are  degenerated.  The 
spleen  is  often  enlarged,  and  there  is  degeneration  of  the 
muscles,  heart  and  kidneys. 

Symptoms. — During  the  first  two  weeks  of  the  disease 
there  are  no  symptoms  except  jaundice.  Dangerous  symp- 
toms then  rapidly  develop,  among  which  may  be  enumerated, 
headache,  delirium  and  excessive  vomiting.  Hemorrhages 
into  the  mucous  membranes  occur.  The  patient  soon  passes 
into  collapse  and  the  typhoid  state.  Stools  become  clay-col- 
ored, or  contain  blood.  There  is  usually  no  fever,  except 
occasionally  just  before  death. 

Treatment. — Adjust  the  middle  dorsal  vertebrae.  Other- 
wise treatment  is  symptomatic. 

Jaundice  (Acute  Catarrh  of  the  Bile  Ducts) 

Etiology. — Among  the  most  common  causes  of  jaundice 
may  be  inentioned  an  extension  of  a  catarrhal  inflammation 


DISEASES  OF  DIGESTIVE  SYSTEM  479 

from  the  stomach  or  duodenum,  gall-stones,  rapid  congestion 
of  the  liver,  emotions,  and  infectious  fevers. 

Pathology. — There  is  inflammation  of  the  duodenum,  and 
the  mucous  lining  of  the  bile  passages ;  as  a  result  of  this  con- 
dition the  mucous  lining  of  the  gall  ducts  become  thickened, 
and  closure  of  the  bile  passages  take  place,  thus  obstructing 
the  outward  flow  of  bile  into  the  intestines.  The  bile  which 
is  thus  retained  in  the  bile  passages  in  the  liver  is  absorbed 
by  the  blood,  and  tingeing  of  the  skin  follows. 

Symptoms. — The  characteristic  symptom  is  a  3'ellowish 
discoloration  of  the  skin  and  mucous  membranes. 

Other  symptoms  are  clay-colored  stools  and  constipation, 
pruritus,  hemophilia,  gastro-intestinal  disturbances,  debility, 
insomnia,  and  mental  dulness. 

Treatment. — Adjust  the  mid-dorsal  vertebrae.  The  best 
method  of  treatment  is  a  change  of  climate,  and  correction  of 
the  mode  of  life.  The  bowels  should  be  kept  open  with  a 
daily  enema.  Hot  baths  should  be  given  every  day.  Rectal 
dilatation  is  also  a  very  useful  measure.. 

Gall  Stones  (Cholelithiasis) 

Etiology. — The  primary  cause  of  this  disease  is  an  inter- 
ference with  the  conduction  of  those  nerve-impulses  to  the 
liver  which  govern  its  secretory  activity,  and  consequently 
the  character  of  the  bile.  It  is  from  these  changed  secretions 
of  the  liver  that  the  calculi  are  partly  or  entirely  derived.  In 
some  cases  bacteria,  especially  the  typhoid  bacilli,  form  the 
nucleus  about  which  the  bile  salts  deposit  to  form  a  stone; 
at  other  times  hardened  mucous  is  the  nucleus  of  the  stone. 
The  disease  is  commonly  seen  in  women  around  the  age  of 
40  years,  and  is  predisposed  to  by  obesity,  sedentary  habits, 
tight  lacing,  previous  typhoid  fever,  and  excessive  eating  and 
drinking. 

Symptoms. — In  most  cases  of  gall  stones  no  symptoms  are 
present.  It  is  only  when  the  stone  becomes  lodged  in  one 
of  the  ducts  that  symptoms  develop.  If  the  stone  is  situated 
in  the  common  duct,  or  the  hepatic  duct,  jaundice  is  present, 
owing  to  the  obstruction  to  the  outflow  of  bile.  In  addition 
to  jaundice,  when  the  stone  is  lodged  in  the  common  .duct, 
the  bladder  is  also  distended,  and  is  readily  palpable  beneath 


480  SPINAL  ADJUSTMENT 

the  free  border  of  the  ribs,  at  about  the  apex  of  the  9th  rib. 
Upon  the  obstruction  of  a  duct  by  a  gall  stone,  hepatic  colic 
develops,  and  is  recognized  by  the  agonizing  pain  which  is 
experienced  in  the  right  side  of  the  abdomen,  and  which  is 
referred  to  the  right  shoulder.  Fever  may  be  present,  and 
persistent  vomiting  and  symptoms  of  collapse  may  supervene. 
Such  an  attack  may  last  from  a  few  minutes  to  several  days. 
Treatment. — Adjust  the  7th  to  10th  dorsal  vertebrae.  Ap- 
ply hot  compresses  over  the  right  side  of  the  abdomen.  Give 
a  high  rectal  enema.  The  patient  should  drink  large  amounts 
of  water,  especially  mineral  water.  Rectal  dilatation  may  be 
of  assistance  in  the  treatment.  Complete  rest  in  bed  is  essen- 
tial. 

Diseases  of  the  Pancreas 

Acute  Pancreatitis 

Etiology. — The  primary  cause  of  this  disease  is  a  disturb- 
ance of  the  innervation  to  the  gland,  as  a  result  of  which  its 
functional  activity  and  organic  integrity  are  impaired.  The 
disease  occurs  in  three  forms :  (a)  the  hemorrhagic  form 
which  is  seen  most  commonly  in  males  of  middle  life,  in 
alcoholics,  and  may  also  be  due  to  the  entrance  of  bile  into 
the  pancreatic  ducts,  (b)  The  suppurative  form,  which  may 
result  from  impacted  gall-stones,  infectious  diseases  and 
trauma,  (c)  The  gangrenous  form,  which  follows  the  hemor- 
rhagic form  in  some  cases.  It  may  also  follow  the  suppurative 
form,  or  result  from  perforation  of  a  gastric  ulcer  into  the 
pancreas. 

Pathology. — In  hemorrhagic  pancreatitis  the  gland  is  en- 
larged, and  is  the  seat  of  hemorrhages  and  necrosis  of  the 
gland-cells.  In  suppurative  pancreatitis  one  or  more  abscesses 
or  diffused  purulent  infiltration  is  present.  In  the  gangrenous 
form,  the  pancreas  is  converted  into  a  soft,  grey  mass. 

Symptoms. — Symptoms  of  the  hemorrhagic  form  are  sud- 
den onset  with  colicky  pain  in  the  epigastric  region,  nausea 
and  vomiting,  followed  by  symptoms  of  collapse.  The  ab- 
domen is  distended ;  fever  and  delirium  are  present.  The 
symptoms  of  the  suppurative  form  run  a  more  chronic  course, 
and  there  are  periods  during  which  no  symptoms  are  present, 
alternating   with   attacks   in   which   the   following  symptoms 


DISEASES  OF  DIGESTIVE  SYSTEM  481 

are  present,  in  addition  to  those  previously  mentioned :  The 
urine  contains  sugar,  jaundice  is  present,  and  the  stools  con- 
tain a  large  amount  of  fat.  The  symptoms  of  the  gangrenous 
form  are  the  same  as  those  mentioned  under  the  other  two 
headings. 

Treatment. — Adjust  the  9th  to  12th  thoracic  vertebrae. 
Concussion  of  the  4th  and  5th  thoracic  vertebrae.  Hot  packs 
should  be  applied  over  the  epigastric  region. 

Chronic  Pancreatitis 

Etiology. — This  disease  usually  follows  the  acute  form,  as 
a  result  of  the  production  of  reflex  subluxations  in  the  seg- 
ments controlling  the  pancreas,  and  which  lesions  obstruct 
the  outflow  of  impulses  to  the  pancreas,  which  are  essential 
to  its  organic  integrity.  It  also  follows  obstruction  of  the 
pancreatic  ducts,  by  stones,  or  the  extension  of  an  inflamma- 
tion into  the  pancreas  from  the  duodenum.  It  is  also  some- 
times due  to  syphilis. 

Pathology. — The  pancreas  is  increased  or  diminished  in 
size,  and  hard. 

Symptoms. — The  symptoms  of  chronic  pancreatitis  are 
very  similar  to  those  of  the  acute  form,  but  are  milder  and 
run  a  more  chronic  course.  The  most  characteristic  symp- 
toms are  jaundice,  the  presence  of  sugar  in  the  urine,  and 
fatty  stools. 

Treatment.— Adjust  the  9th  to  the  12th  thoracic  vertebrae. 
Concussion  of  the  4th  and  5th  dorsal  vertebrae.  Correct  the 
diet. 

Cancer  of  the  Pancreas 

Etiology. — This  disease  is  very  rare,  and  the  growth  is 
usually  primary,  and  of  the  scirrhous  variety.  It  is  most  com- 
mon in  men  past  middle  life. 

Symptoms. — The  most  characteristic  symptom  is  the  en- 
largement of  the  pancreas  which  is  nodular  when  palpated  in 
the  epigastric  region.  Other  symptoms  are  jaundice,  fatty 
stools,  and  glycosuria.  In  connection  with  these  symptoms 
there  may  be  present  gastric  disturbances,  a  dull  pain  in  the 
epigastrium,  and  finally  cachexia  develops. 

Treatm<;nt. — Adjust  the  9th  to  the  12th  thoracic  vertebrae. 


4,82  SPINAL  ADJUSTMENT 

Concussion  of  the  4th  and  5th  thoracic  vertebrae.  The  treat- 
ment is  largely  symptomatic,  and  in  the  main  the  prognosis 
is  hopeless. 

Cysts  of  the  Pancreas 

Etiology. — Cysts  of  the  pancreas  are  usually  of  the  reten- 
tion variety,  that  is  to  say,  due  to  an  obstruction  to  the  out- 
flow of  the  pancreatic  juice,  as  a  result  of  closure  of  the  duct 
of  the  pancreas  by  tumors  or  calculi.  They  may,  however, 
also  be  due  to  echinococcus  or  malignant  tumors. 

Symptoms. — The  most  characteristic  symptom  is  the  pres- 
ence of  an  enlargement  in  the  left  side  of  the  epigastric  region, 
which  is  lobular  in  outline,  and  resisting.  Associated  with 
this  condition  are  jaundice,  abdominal  pain,  digestive  dis- 
turbances, loss  of  flesh  and  strength,  and  clay-colored  stools. 

Treatment. — Adjust  the  9th  to  12th  thoracic  vertebrae, 
and  use  concussion  of  the  4th  and  5th  thoracic  vertebrae. 
Otherwise  the  treatment  is  surgical. 

Pancreatic  Calculi 

Etiology. — The  primary  cause  of  calculi  in  the  pancreas 
or  its  ducts,  is  an  obstruction  to  the  outflow  of  those  nerve- 
impulses  which  govern  the  secretory  activity  of  the  glands. 
As  a  result  of  the  withdrawal  of  this  innervation,  the  secre- 
tion undergoes  changes  from  the  normal,  and  may  contain 
dried  particles,  around  which  salts  deposit,  forming  stones. 

Symptoms. — No  characteristic  symptoms  may  be  present, 
or  there  may  be  colicky  pains  in  the  epigastrium,  vomiting, 
fatty  stools,  and  the  passage  of  the  stones  in  the  stools. 

Treatment. — Adjust  the  9th  to  12th  thoracic  vertebrae,  and 
use  concussion  over  the  4th  and  5th  thoracic  vertebrae.  A 
high  rectal  enema  of  normal  salt  solution  is  efificient  in  some 
cases.  For  the  colicky  pains,  hot  compresses  should  be  ap- 
plied over  the  epigastric  region.  During  the  paroxysms  the 
patient  should  be  placed  in  bed. 

Diseases  of  the  Peritoneum 

Acute   General  Peritonitis 

Etiology. — Secondary  peritonitis  may  be  due  to  the  ex- 
tension  of  the  inflammation   from  one  of  the  abdominal  or- 


DISEASES  OF  DIGESTIVE  SYSTEM  483 

gans,  or  from  penetrating  wounds.  The  most  common  cause 
of  peritonitis,  however,  is  perforation.  Primary  peritonitis 
results  from  exposure  to  cold  and  wet,  and  may  occur  late  in 
the  course  of  Bright's  disease,  arterio-sclerosis,  and  gout. 

Pathology. — There  is  local  and  general  congestion  of  the 
peritoneum.  The  intestines  are  distended,  and  their  coils  are 
adhered  to  one  another. 

Symptoms. — The  onset  is  very  sudden,  with  a  chill,  and 
symptoms  of  collapse.  This  is  followed  by  a  rapid  rise  of 
temperature,  and  extreme  tenderness  and  pain  of  the  ab- 
domen. The  muscles  over  the  affected  area  are  rigid,  and  the 
knees  are  flexed  on  account  of  the  intense  pain.  Tympanites 
and  absolute  constipation  are  present.  The  face  has  an 
anxious  expression,  and  is  pinched.  There  is  excessive  vomit- 
ing. 

Treatment. — The  treatment  is  primarily  directed  toward 
the  seat  of  the  cause.  Adjustment  should  therefore  be  made 
in  those  segments  which  control  the  parts  involved.  Adjust 
also  subluxations  which  may  be  found  from  the  8th  to  the 
12th  dorsal,  and  from  the  1st  to  2nd  lumbar  vertebrae.  Rest 
in  bed  and  absolute  quiet  should  be  maintained.  Hot  com- 
presses over  the  abdomen,  and  rectal  dilatation  are  very  im- 
portant accessory  methods  of  treatment.  Hot  enemas  may 
also  be  given.  Ice,  milk,  and  cham-pagne  may  be  given,  if  the 
stomach  is  able  to  retain  them.  For  vomiting,  pieces  of  ice 
may  be  dissolved  in  the  mouth.  When  the  peritonitis  is  due 
to  perforation,  surgical  measures  are  necessary. 

The  above  treatment  may  also  be  used  in  Chronic  peri- 
tonitis, but  in  most  cases  surgical  measures  are  required. 

Ascites   (Dropsy) 

Etiology. — This  condition  may  accompany  the  general 
dropsy  which  occurs  in  diseases  of  the  heart,  liver  and  kid- 
neys. It  is  also  due  to  chronic  peritonitis,  abdominal  tumors, 
and  obstruction  of  the  portal  circulation. 

Symptoms. — The  abdomen  is  uniformly  distended,  and 
globular.  The  superficial  abdominal  veins  are  enlarged.  On 
percussion  a  flat  note  is  obtained  in  the  most  dependent  por- 
tions, and  a  change  of  the  position  of  the  patient  will  cause 
a  variation  in  the  level  of  flatness.     If,  while  the  patient  is 


484  SPINAL  ADJUSTMENT 

lying  on  the  back,  the  lumbar  region  on  one  side  is  slightly 
tapped,  the  impulse  of  the  fluid  may  be  felt  on  the  other  side. 
Tympanitic  resonance  may  be  elicited  on  percussion  in  the 
epigastric  region. 

Treatment. — Treatment  must  be  directed  to  the  primary 
cause  of  the  dropsy.  Adjust  the  6th  to  the  10th  thoracic  ver- 
tebrae, the  10th  for  its  diuretic  and  diaphoretic  efifect.  Con- 
cussion of  the  7th  cervical  vertebra,  and  from  the  3rd  to  the 
8th  thoracic  vertebrae.     Hot  baths  daily. 


CHAPTER  IX 

Diseases  of  the  Nervous  System 

Diseases  of  the  Cerebrum 
Meningitis 

1.  Pachymeningitis  (Inflammation  of  the  dura  mater). 
Etiology. — This  affection  exists  in  two  forms :    It  is  called 

Pachymeningitis  Externa  when  the  external  layer  of  the  dura 
mater  is  first  affected;  Pachymeningitis  Interna,  when  the 
inner  layer  of  the  dura  is  first  affected.  Pachymeningitis  ex- 
terna is  produced  by  injuries  of  the  skull,  and  is  purely  a 
surgical  affection.  Pachymeningitis  interna  is  due  to  trauma 
of  the  head,  Bright's  disease,  tuberculosis,  syphilis,  scurvy 
and  alcoholism.  It  may  also  result  from  the  extension  of  a 
suppurative  process  from  the  middle  ear.  Gout,  erysipelas 
and  sunstroke  have  also  been  noted  as  having  caused  the  con- 
dition. 

Pathology. — The  dura  mater  is  first  congested,  following 
which  it  is  covered  with  an  exudation  which  becomes  organ- 
ized into  a  new  membrane,  which  contains  many  blood  ves- 
sels, having  thin  walls,  and  from  which  hemorrhages  fre- 
quently occur.  When  the  disease  is  due  to  syphilis,  the  dura 
is  covered  with  gummata,  which  may  degenerate  and  form 
caseous  masses,  or  be  liquified  and  converted  into  pus. 

Symptoms. — The  characteristic  symptoms  of  this  affec- 
tion are  constant  headaches,  insomnia,  dizziness,  aversion  to 
light,  and  impairment  of  the  physical  and  mental  faculties. 
These  symptoms  are  followed  by  convulsions,  delirium,  and 
coma,  or  by  apoplectiform  attacks  and  paralysis.  Epileptic 
attacks  are  prone  to  occur. 

2.  Acute  Leptomeningitis. 

Etilogy. — Acute  leptomeningitis  is  an  intlanimation  of  the 
arachnoid  and  pia  mater,  and  is  often  seen  in  the  course  of 
acute  infections  fevers.     It  may  follow  disease  of  the  cranial 

485 


486  SPINAL  ADJUSTMENT 

bones,  or  of  the  middle  ear,  or  be  secondary  to  a  tubercular 
process  in  some  other  part  of  the  body.  Other  causes  may 
be  insomnia,  acute  alcoholism,  sunstroke,  syphilis  and  over- 
work. The  primary  form  is  due  to  a  low  grade  of  resistance 
of  these  membranes,  rendering-  them  susceptible  to  the  in- 
vasion of  the  exciting  form,  which  is  the  diplococcus  intra- 
cellularis.  The  secondary  form  is  due  to  the  various  bacilli 
which  are  the  cause  of  the  acute  infectious  diseases  which  it 
frequently  complicates,  primarily  induced  by  a  low  grade  of 
resistance. 

Pathology.— There  is  at  first  hyperemia  of  the  pia  and 
arachnoid ;  this  is  followed  by  an  exudation  of  a  serous  fluid, 
which  later  becomes  fibrinous  and  finally  purulent.  This 
purulent  exudation  fills  the  arachnoid  space,  and  when  mixed 
with  the  cerebro-spinal  fluid,  renders  it  turbid.  As  a  result 
of  the  inflammatory  process  the  meninges  become  thickened, 
and  adhesions  are  formed. 

Symptoms. — The  disease  may  commence  very  suddenly, 
but  usually  the  onset  is  gradual  and  characterized  by  malaise, 
headache,  vertigo,  irritability,  vomiting,  rise  in  temperature, 
restlessness,  and  a  lack  of  desire  to  move  about.  Following 
these  prodromal  symptoms,  the  disease  is  initiated  by  severe 
chill,  and  a  rapid  rise  in  temperature  and  increase  in  the  pulse- 
rate.  The  eyes  are  congested,  there  is  violent  headache,  aver- 
sion to  light,  dizziness,  nausea  and  vomiting,  tinnitus,  and 
delirium.  The  stage  of  excitation  next  follows,  the  character- 
istic symptoms  of  which  are  hyperesthesia  of  the  skin,  wild 
delirium,  spasms  of  the  muscles,  opisthotonos  and  convulsions. 
Temperature  is  high,  and  the  pulse  slow  and  irregular.  In- 
tense headache  continues.  The  duration  of  this  stage  of  the 
disease  may  be  one  day  or  as  long  as  two  weeks. 

If  the  stage  of  collapse  develops,  various  pressure  symp- 
toms, due  to  the  increase  of  the  exudation  develop.  The  de- 
lirium subsides,  and  the  muscular  spasms  diminish.  The 
patient  gradually  passes  into  deep  coma. 

Treatment. — The  patient  should  occupy  a  quiet,  well-ven- 
tilated room.  The  head  should  be  elevated,  and  an  ice-bag 
applied  to  relieve  the  headache.  The  diet  should  be  liquid. 
Adjustment  is  often  impossible,  owing  to  the  severe  pain 
which  it  induces,  together  with  the  difficulty  in  moving  the 


DISEASES  OF  NERVOUS  SYSTEM  487 

patient.  Continued  pressure  applied  on  the  nerves  controlling 
segments  which  are  painful  will  sometimes  very  speedily  over- 
come the  pain  and  produce  relaxation.  x\lternating  cold  and 
hot  applications  over  the  spine  are  useful  measures.  Rectal 
dilatation  has  also  proven  to  be  of  value  in  many  cases.  Ad- 
justments should  be  made  of  the  1st  and  2nd  cervical  verte- 
brae, and  of  any  other  subluxations  which  may  be  found. 

Cerebral  Congestion   (Congestion  of  the  Brain) 

Etiology. — Congestion  of  the  brain  is  seen  in  two  forms : 
when  due  to  fulness  of  the  arterial  capillaries,  it  is  known  as 
active  congestion ;  when  occasioned  by  fulness  of  the  venous 
capillaries,  it  is  known  as  passive  congestion.  The  most 
common  causes  of  active  congestion  of  the  brain  are  a  de- 
creased amount  of  blood  in  other  parts  of  the  body,  enlarge- 
ment of  the  heart,  a  general  plethoric  condition,  prolonged 
mental  labor,  acute  alcoholism,  excessive  eating  and  drinking, 
and  sunstroke.  The  usual  causes  of  passive  congestion  of  the 
brain  are  pressure  upon  the  veins  which  convey  the  blood 
aw^ay  from  the  brain,  dilatation  of  the  right  side  of  the  heart, 
and  anything  which  interferes  with  the  venous  circulation. 
Passive  congestion  is  due  usually  to  a  subluxation  in  the  upper 
cervical  region,  which  produces  pressure  on  the  vertebral 
veins.  Reflex  subluxations,  produced  by  some  of  the  causes 
above  mentioned,  often  cause  active  congestion  of  the  brain 
by  their  influence  on  the  vasomotor  nerves  of  the  cranium. 

Symptoms. — The  onset  may  be  sudden  or  gradual.  The 
characteristic  symptoms  are  paroxysmal  headaches,  ringing 
in  the  ears,  deafness,  amblyopia,  contracted  pupils,  dizziness, 
irritability,  confusion,  insomnia,  retraction  of  the  limbs,  red- 
ness of  the  face,  and  sometimes  in  children,  convulsions. 

Treatment. — The  contributing  causes  should,  in  all  cases, 
be  eliminated.  The  patient  should  be  placed  in  a  quiet,  well- 
ventilated  room.  The  head  should  be  elevated,  and  an  ice- 
cap applied  to  it,  and  heat  should  be  applied  to  the  feet.  The 
bowels  should  be  thoroughly  cleansed  by  an  enema.  Adjust 
the  1st  and  4th  cervical  vertebrae.  Concussion  of  the  7th 
cervical  vertebra  and  of  the  1st  and  2nd  cervical.  Rectal 
dilatation  has  been  found  to  be  very  useful  in  the  treatment 
of  these  cases. 


488  SPINAL  ADJUSTMENT 

Cerebral  Anemia 

Etiology .^ — A  diminished  amo'int  of  blood  in  the  cerebral 
vessels  may  be  general,  in  which  case  it  is  the  result  of  sud- 
den shock,  weak  heart  action,  valvular  disease  of  the  heart, 
general  anemia,  hemorrhages,  wasting  diseases,  and  follow- 
ing infectious  fevers  of  a  severe  nature.  The  anemia  may  also 
be  local,  in  which  case  it  is  due  to  the  obstruction  of  a  vessel 
by  an  embolus  or  thrombus. 

Pathology. — The  brain  is  of  a  pale  color,  and  its  ventri- 
cles are  filled  with  fluid.  It  is  upon  the  quality  and  quantity 
of  blood  circulating  in  the  cerebral  vessels,  that  the  normal 
functional  activity  of  the  brain  depends.  If,  therefore,  the 
entire  brain,  or  any  portion  of  it  is  poorly  supplied  with  blood, 
its  function  is  disturbed. 

Symptoms. — The  characteristic  symptoms  of  anemia  of 
the  brain  are  headache,  which  is  relieved  by  lying  with  the 
head  low,  dizziness,  fainting  attacks,  and  occasionally  con- 
vulsions. If  the  anemia  afifect  only  a  portion  of  the 
brain,  those  muscles  supplied  by  the  affected  area  will  be 
temporarily  paretic. 

Treatment. — The  causes  of  the  cerebral  anemia  must  first 
of  all  receive  attention,  and  if  it  is  due  to  a  general  anemia, 
the  treatment  should  -be  directed  toward  the  relief  of  this 
condition.  The  patient  should  spend  a  number  of  hours  each 
day  lying  down.  Adjust  the  1st  and  2nd  cervical  vertebrae. 
Concussion  of  the  10th  dorsal  vertebra. 

Cerebral  Hemorrhage 

Etiology. — Cerebral  hemorrhage,  or  apoplexy  is  due  pri- 
marily to  arteriosclerosis,  which  is  itself  due  to  faulty  metab- 
olism, occasioned  by  faulty  innervation.  Anything  which 
subsequently  tends  to  raise  the  blood  pressure  may  cause  the 
rupture  of  one  of  these  arteries  in  the  brain,  and  a  more  or 
less  severe  hemorrhage  result. 

Pathology. — Cerebral  hemorrhage  occurs  most  frequently 
in  the  region  supplied  by  the  central  arteries,  namely  the  stri- 
ate body,  optic  thalamus,  and  internal  capsule.  They  occur 
less  frequently  in  the  cerebellum,  still  less  commonly  in  the 
pons  and  medulla,  and  very  rarely  on  the  convexity  of  the 
brain,  in  which  case  they  are  known  as  meningeal  hemorrhage. 


DISEASES  OF  NERVOUS  SYSTEM  489 

Symptoms. — In  some  cases  there  may  be  prodromal  symp- 
toms, while  in  other  cases  the  attack  occurs  without  the 
slightest  warning.  When  prodromal  symptoms  arc  present, 
they  include  headache,  vertigo,  irritability,  and  numbness  in 
the  extremities  of  one  side.  In  a  typical  case  of  apoplexy  the 
patient  falls  suddenly,  there  is  a  marked  mental  confusion, 
but  not  necessarily  loss  of  consciousness  in  a  simple  case. 
There  is  more  or  less  paralysis  on  the  one  side.  In  a  more 
severe  attack  the  patient  falls  after  having  lost  consciousness 
completely ;  there  is  sterterous  breathing,  the  face  is  flushed, 
the  eyes  are  congested,  the  eyelids  closed,  and  there  is  pro- 
fuse perspiration  of  the  entire  body.  In  cases  which  end  in 
death,  the  temperature  soon  becomes  subnormal.  In  other 
cases,  where  death  does  not  occur  at  once,  the  temperature 
gradually  rises  until  it  reaches  107  or  108  just  before  death. 
In  those  cases  which  terminate  favorably,  the  temperature 
drops  gradually  to  normal. 

After  a  more  or  less  prolonged  period,  the  patient  partially 
regains  the  use  of  the  limbs,  and  is  able  to  walk  about,  al- 
though the  limbs  are  stifif,  and  the  joints  are  painful  and 
swollen.  The  reflexes  are  exaggerated  on  the  affected  side, 
but  there  is  no  muscular  atrophy.  If  muscular  atrophy  does 
take  place,  as  occurs  sometimes,  it  is  an  indication  that  a 
secondary  lesion  has  occurred  in  the  spinal  cord.  The 
mentality  is  slowly  and  incompletely  restored. 

Treatment. — When  the  patient  is  seen  immediately  after 
the  occurrence  of  the  hemorrhage,  his  clothing  should  be 
loosened,  and  he  should  be  placed  in  a  horizontal  position, 
with  the  head  slightly  raised.  An  ice  bag  should  be  applied 
to  the  head  and  a  hot  pack  to  the  feet.  Adjust  the  1st  and  2nd 
cervical  vertebrae.  Concussion  of  the  1st,  2nd  and  7th  cerv- 
ical vertebrae.  Later  on  the  patient  should  be  given  hot 
baths ;  during  the  time  that  he  is  in  the  bath,  cold  compresses 
should  be  applied  to  the  head.  The  various  sequelae  to 
apoplexy  should  be  treated  by  proper  adjustment  and  massage, 
and  passive  movements. 

Headache 

Etiology. — Headache  is  a  symptom  rather  than  a  disease, 
and  the  cause  should  be  looked  for  in  everv  case.    Among  the 


490  SPINAL  ADJUSTMENT 

more  common  causes  of  pain  in  the  head  may  be  mentioned 
migraine,  neuralgia  and  neuritis.  Remote  causes  of  pain  in  the 
head  are  anemia,  hemorrhage,  Bright's  disease,  constitutional 
diseases,  infectious  diseases,  intoxication,  neuroses,  fatigue, 
impure  air,  acclimation,  reflex  or  referred  pain  from  other  parts 
of  the  body,  and  organic  diseases  of  the  nervous  system. 

Symptoms. — The  character  of  the  headache  is  of  great 
assistance  in  determining  the  cause  thereof.  Thus  in  neu- 
ralgia the  pain  is  sharp,  lancinating  and  paroxysmal ;  in  mi- 
graine or  hemicrania,  the  headache  is  pulsating  or  throbbing, 
paroxysmal  and  unilateral ;  in  gastro-intestinal  diseases  and 
infectious  fevers,  the  headache  is  dull,  heavy  and  general,  and 
is  increased  by  shaking  the  head ;  in  neurasthenia  the  head- 
ache is  binding  or  pressing ;  in  anemia  and  rheumatism  the 
headache  is  a  hot  and  burning  pain ;  in  epilepsy  and  hysteria 
the  pain  is  sharp  and  boring.  The  location  of  the  pain  in  the 
head  is  also  of  value,  in  determining  the  producing  cause. 
Thus  a  headache  caused  by  anemia  is  usually  frontal ;  head- 
aches due  to  hysteria  afifect  the  vertex ;  neurasthenic  head- 
aches usually  afifect  the  vertex,  and  sometimes  are  described 
as  a  tight-band  about  the  head ;  headaches  due  to  catarrh  of 
the  nose  and  throat  begin  at  the  root  of  the  nose,  and  extend 
directly  backward  to  the  occiput,  and  are  greatly  increased 
by  coughing  and  bending  forward ;  headaches  due  to  ocular 
defects  are  frontal  or  occipal ;  headaches  due  to  constipation 
or  indigestion  are  frontal  and  orbital,  and  are  made  worse  by 
sudden  movements  of  the  head ;  in  headaches  due  to  pelvic 
disorders,  the  pain  is  experienced  chiefly  on  the  top  of  the 
head,  and  in  the  occipital  region. 

Treatment. — Primary  attention  should  be  directed  towards 
relief  of  the  cause  of  the  headache.  Attention  should  next  be 
directed  toward  the  relief  of  the  headache  itself,  and  this  can 
be  accomplished  in  nearly  all  cases  by  adjustment  of  the  1st 
and  4th  cervical  vertebrae.  Accessory  methods  of  treatment 
should  be  applied  as  indicated. 

Diseases  of  the  Spinal  Cord 

Acute  Anterior  Poliomyelitis  (Infantile  Paralysis) 

Etiology. — This  disease  is  seen  most  commonly  in  chil- 
dren between  the  ages  of  one  and  three  years.    It  occurs  most 


DISEASES  OF  NERVOUS  SYSTEM  491 

commonly  in  the  summer  months.  Frequently  it  follows  a 
prolonged  diarrhea,  or  some  of  the  exanthemata.  Its  con- 
tagious nature  seems  to  indicate  that  it  is  of  an  infectious 
character,  although  the  exact  nature  of  the  producing  organ- 
ism has  not  as  yet  been  determined.  Spinal  adjustment  is 
exceedingly  beneficial  in  these  cases,  and  acute  subluxations 
may  therefore  justly  be  considered  as  predisposing  causes. 

Pathology. — The  anterior  horns  of  the  spinal  cord  of  the 
affected  segments  are  congested,  and  small  hemorrhages  into 
the  gray  matter  of  the  cord  are  found.  Various  degrees  of 
parenchymatous  degeneration  are  present.  The  ganglion  cells 
are  swollen,  granular,  and  their  processes  are  indistinctly  seen 
under  the  microscope.  In  post-mortem  examinations  made 
some  years  after  the  occurrence  of  the  disease,  it  is  seen  that 
the  anterior  horn  is  shrunken,  and  the  ganglion  cells  are 
replaced  by  fibrous  tissue. 

Symptoms. — The  onset  is  usually  very  sudden,  the  child 
going  to  bed  apparently  in  perfect  health,  and  being  found 
the  next  morning  with  some  of  the  extremities  paralyzed  • 
Often  the  disease  is  initiated  by  convulsions,  and  a  high  fever 
follows,  which  is  of  short  duration.  The  lower  limbs  are 
paralyzed  more  often  than  the  upper.  At  first  for  a  few  hours 
or  days  there  is  extreme  pain  in  the  affected  limbs,  but  this 
subsides.  In  a  week  or  two  most  of  the  paralyzed  muscles 
recover,  leaving  other  groups  more  or  less  permanently  af- 
fected, depending  upon  the  degree  of  destruction  of  the  gang- 
lion cells  in  the  cord.  Any  group  of  muscles  may  thus  remain 
affected,  but  the  perinei  muscles  of  the  lower  extremities  are 
most  often  paralyzed.  No  sensory  disorders  are  present,  but 
the  reflexes  are  lost.  The  parts  which  remain  paralyzed  soon 
evidence  trophic  disturbances,  as  noted  by  the  atrophy  of 
the  muscles,  the  coldness  of  the  surface,  and  the  poor  circula- 
tion. In  many  cases  the  atrophy  of  the  muscles  becomes 
extreme,  and  as  a  result  of  this,  various  deformities  occur. 
As  the  child  grows  older,  the  paralyzed  limb,  if  left  untreated, 
does  not  develop  as  does  the  healthy  one,  and  the  bones  are 
shorter  and  smaller  in  the  affected  limb  than  in  the  healthy 
one. 

Treatment. — A  careful  and  searching  spinal  analysis  must 
be   made,   paying  especial   attention   to   the   segments   which 


492  SPINAL  ADJUSTMENT 

govern  the  paralyzed  muscles.  Subluxations  should  be  ad- 
justed every  other  day,  and  if  treatment  is  persisted  in,  it 
will  be  followed  by  almost  complete  recovery,  in  all  cases,  and 
total  cure  in  most  cases.  Valuable  accessory  measures  are 
the  galvanic  current,  and  massage  of  the  affected  limb.  The 
diet,  hygiene,  and  the  general  health  of  the  patient  must  be 
carefully  attended  to. 

Locomotor  Ataxia  (Tabes  Dorsalis') 

Etiology. — Locomotor  ataxia  is  a  degeneration  of  the  pos- 
terior column  and  posterior  nerve  roots  of  the  spinal  cord, 
and  is  considered  in  every  case  to  be  due  to  syphilis.  Con- 
tributing causes  such  as  alcoholism,  exposure,  hardship,  and 
injuries  have  some  influence  in  its  production. 

Pathology. — The  disease  process  affects  both  the  central 
and  the  peripheral  nervous  system.  The  principal  lesions  are 
located  in  the  sensory  tract  of  the  spinal  column  and  in  the 
ganglia  and  roots  of  the  posterior  columns  of  the  cord.  The 
•  optic  nerve  is  especially  affected,  and  this  is  considered  due 
to  the  fact  that  the  optic  nerve  is  really  an  extension  of  the 
cerebral  substance.  The  morbid  changes  generally  commence 
in  the  dorso-lumbar  portion  of  the  cord,  and  are  most  marked 
in  that  region. 

Symptoms. — Symptomatically  the  disease  is  divided  into 
two  stages :  First,  the  prodromal  stage ;  second,  the  ataxic 
stage.  The  symptoms  of  the  prodromal  stage  are  divided  into 
the  subjective  symptoms  and  the  objective  symptoms. 

The  subjective  symptoms  which  are  characteristic  of  the 
prodromal  stage  are  lightning  pains  in  different  parts  of 
the  body,  especially  the  lower  limbs.  Following  the  pain, 
abnormalitis  of  sensation  appear,  which  may  consist  of  itch- 
ing, numbness,  or  a  sensation  in  the  feet  as  though  the  patient 
were  walking  on  a  thick  pad  of  cotton.  The  most  character- 
istic disturbance  of  sensation,  however,  is  the  girdle  sensa- 
tion, which  is  a  feeling  of  constriction  about  the  waist  as 
though  a  tight  band  were  drawn  around  it.  There  is  a  feeling 
of  weakness  or  uncertainty  in  the  lower  limbs.  Slight  blad- 
der and  sexual  disturbances  are  present.  Any  of  the  follow- 
ing ocular  disturbances  may  be  present :  Squint,  double-vision, 
or  impaired  vision ;   optic   atrophy   commences   early   in   the 


DISEASES  OF  NERVOUS  SYSTEM  493 

disease  in  many  cases,  and  is  the  first  thing  to  draw  the 
patient's  attefition  to  his  condition. 

Objective  symptoms  which  are  present  in  the  prodromal 
stage  are  Romberg's  sign,  which  is  a  symptom  of  incoordina- 
tion, and  is  shown  by  swaying  of  the  patient  on  standing  with 
the  eyes  closed.  The  Argyll-Robertson  pupil  is  present.  The 
knee-reflex  is  lost.  Sensibility  to  temperature  and  pain 
is  diminished.  The  space  sense  is  interfered  with,  the 
muscle  sense  is  retained,  and  the  sense  of  touch  is  not  greatly 
affected. 

The  ataxic  stage  is  characterized  chiefly  by  the  presence 
of  motor  symptoms,  which  are  not  due  to  involvment  of  the 
motor  tract  of  the  cord,  but  are  due  to  incoordination.  The 
characteristic  symptom  is  the  ataxic  gait.  Incoordination  of 
the  muscles  becomes  more  and  more  marked,  and  the  sensa- 
tion of  posture  and  position  of  the  limbs  entirely  disappears. 
Crises  of  pain  occur  in  all  cases,  the  gastric  crises  being 
diagnostic.  Disturbances  in  micturition  and  defecation  and 
loss  of  sexual  power  may  occur  early  or  late  in  the  disease. 
The  patient's  condition  is  finally  terminated  by  paralysis,  or 
death  is  a  result  of  an  intercurrent  affection,  most  commonly 
pneumonia. 

Treatment. — Adjust  the  1st  and  2nd  cervical  vertebrae, 
the  upper  dorsal,  and  the  lumbar  vertebrae.  A  careful  spinal 
analysis  should  be  made  in  every  case,  to  determine  the  exist- 
ence of  subluxations,  and  these  may  vary  in  their  occurrence. 
Concuss  the  11th  dorsal  certebra.  Apply  pressure  for  about 
one  minute  upon  those  nerves  which  supply  afifected  parts, 
for  the  relief  of  the  various  forms  of  crises.  In  the  ataxic 
stage,  traction  from  two  to  five  minutes  every  day  is  a  val- 
uable measure.  In  all  cases,  the  patient  should  be  confined 
to  bed  for  a  long  period  of  time.  He  should  be  removed  from 
all  excitement,  mental  exertion,  and  wotry.  By  all  means,  as 
a  well  regulated  diet,  attention  to  the  eliminative  organs,  and 
general  hygienic  measures,  the  health  of  the  patient  should 
be  improved  as  much  as  possible.  Massage  and  systematic 
exercises  are  very  beneficial,  and  should  be  applied  in  all 
cases.  During  the  ataxic  stage  the  patient  should  practice 
exercises  which  will  restore  the  power  of  coordination.  Many 
methods  of  doing  this  are  used,  and  the  operator  may  use 


494  SPINAL  ADJUSTMENT 

any  system  or  method  which  seems  suitable  to  the  particular 
case  which  he  is  treating.  Cold  packs  along  the  spine  are 
very  beneficial.  The  galvanic  current  should  be  applied  along 
the  spine,  and  the  faradic  current  to  the  wasting  muscles. 
Otherwise  the  treatment  is  symptomatic. 

Acute  Myelitis  (Transverse  Myelitis) 

Etiology. — Inflammation  of  the  substance  of  the  spinal 
cord  may  be  due  to  exposure  to  cold  and  wet,  injuries  of  the 
vertebrae  or  subluxation  thereof ;  or  it  may  occur  as  a  sequel 
to  puerperal  fever,  typhoid  fever,  syphilis,  rheumatism,  erup- 
tive fevers,  and  intoxications.  It  may  also  be  a  sequel  to 
congestion  of  the  spinal  cord,  or  spinal  meningitis. 

Pathology. — The  inflammation  of  the  spinal  cord  may 
affect  the  gray  or  the  white  substance;  it  may  be  limited  to 
certain  sections  of  the  cord,  or  affect  the  entire  cord.  The 
progress  of  the  inflammation  may  be  in  an  upward  direction, 
or  downward,  or  transversely.  The  nerve  structures  of  the 
cord  undergo  fatty  degeneration,  and  softening  of  the  cord 
may  occur. 

Symptoms. — The  disease  usually  commences  very  sudden- 
ly with  a  chill,  and  rapid  rise  in  temperature,  and  changes  in 
motor  and  sensory  function.  The  back  is  exceedingly  sensi- 
tive, there  is  paresthesia  of  the  limbs,  or  even  complete  anes- 
thesia. The  girdle  sensation,  namely,  a  feeling  as  though  a 
tight  band  were  drawn  about  the  waist,  is  a  characteristic 
symptom  of  this  condition.  As  early  as  the  first  day,  paralysis 
of  the  lower  limbs,  and  the  bladder  and  bowels  occurs.  The 
knee-jerk  is  absent,  as  are  all  the  other  reflexes  of  the  lower 
extremities.  The  muscles  atrophy,  and  the  temperature  of 
the  affected  limbs  is  lowered.  During  the  acute  course  of  the 
disease,  symptoms  common  to  all  acute  disorders,  such  as 
gastrointestinal  disorders,  irregularity  of  the  heart,  dyspnea, 
and  difficult  swallowing  are  present.  Bed-sores  are  prone 
to  develop.  The  urine  is  alkaline  in  reaction  and  cystitis 
finally  develops. 

Treatment. — The  patient  should  be  placed  in  bed,  and  ab- 
solute rest  enforced.  Hot  magnesium  sulphate  compresses 
should  be  applied  along  the  spine.  The  patient  should  be 
sponged  several  times  a  day,  followed  by  an  alcohol  rub,  and 


DISEASES  OE  NERVOUS  SYSTEM  495 

the  liberal  use  of  talcum,  to  prevent  the  formation  of  bed- 
sores. In  cases  where  the  urine  is  retained,  the  catheter 
should  be  used.  Nerve  pressure  along  the  spine  is  very  useful 
to  relieve  the  tenderness.  Later  on  electricity  and  massage 
may  be  used.  A  careful  spinal  analysis  should  be  made,  and 
subluxated  vertebrae  should  be  corrected  as  found. 


Bulbar  Paralysis 

Etiology. — Bulbar  paralysis  is  a  gradually  increasing  paral- 
ysis of  both  sides  of  the  tongue,  lips,  palate,  pharynx  and 
larynx,  due  to  a  degeneration  of  certain  nuclei  in  the  medulla 
oblongata.  The  cause  of  the  degeneration  is  an  injury  in  the 
upper  part  of  the  neck,  whereby  the  atlas  and  axis  are  dis- 
placed. In  the  young  adult,  however,  such  a  displacement 
will  not  produce  bulbar  paralysis,  since  the  disease  is  seldom 
seen  before  the  40th  year  of  life.  Contributing  causes  are 
syphilis,  gout  and  rheumatism. 

Symptoms. — The  disease  commences  very  slowly,  the  first 
symptoms  being  difficulty  in  speech,  owing  to  the  lack  of 
control  of  the  movements  of  the  tongue ;  this  becomes  more 
and  more  pronounced,  until  finally  the  tongue  is  completely 
paralyzed.  From  here  the  paralysis  extends  to  the  muscles 
of  the  pharynx  and  the  soft  palate,  causing  dysphagia.  Next 
the  orbicularis  oris  becomes  paralyzed,  and  prevents  the 
closing  of  the  lips.  Finally  the  muscles  of  the  larynx  are 
paralyzed  and  speech  is  completely  lost.  As  the  paralysis 
of  the  lips  and  tongue  becomes  progressively  more  pro- 
nounced, atrophy  of  the  muscles  sets  in.  As  the  degenerative 
processes  in  the  medulla  increase,  the  nucleus  of  the  vagus 
nerve  becomes  affected,  and  cardiac  and  respiratory  disturb- 
ances develop.  The  inability  of  the  patient  to  swallow 
and  thus  obtain  nourishment,  together  with  the  deficient 
respiratory  activity,  causes  marked  impairment  of  the  health. 

In  addition  to  the  chronic  form  just  described,  there  are 
two  other  varieties,  one  caused  by  hemorrhage  of  the  medulla, 
and  the  other  by  an  inflammatory  condition.  Their  symptoms 
are  the  same  as  those  of  the  chronic  form,  but  their  onset  is 
acute. 

Treatment. — Adjust   the  upper  cervical   vertebrae.     Elec- 


496  SPINAL  ADJUSTMENT 

tricity  and  massage  are  also  useful.     Otherwise  the  treatment 
is  symptomatic. 

Amyotrophic  Lateral  Sclerosis  (Primary  Lateral  Sclerosis;  Spasmodic 

Tabes   Dorsalis) 

Etiology. — This  disease,  which  is  a  degenerative  process 
in  the  lateral  columns  of  the  spinal  cord,  is  seen  chiefly  in 
men  between  the  ages  of  30  and  50  years.  The  exact  mode 
of  production  of  this  condition  is  not  known,  but  it  is  prob- 
ably due  to  a  want  of  proper  innervation  of  the  affected  seg- 
ments of  the  spinal  cord  themselves,  as  a  result  of  which  the 
metabolic  processes  in  the  cord  are  deranged. 

Pathology. — The  morbid  process  is  limited  usually  to  the 
lateral  columns  of  the  spinal  cord,  and  the  anterior  horns  are 
the  ones  affected.  There  is  gradual  wasting  or  degeneration 
of  the  ganglion  cells,  and  an  infiltration  of  fibrous  connective 
tissue  occurs,  sclerosis  of  the  lateral  column  of  the  cord  finally 
developing. 

Symptoms. — The  disease  commences  very  gradually,  and 
almost  at  the  same  time  in  both  the  upper  and  lower  extremi- 
ties. There  is  first  a  sensation  of  weakness  and  weight  in  the 
limbs ;  this  is  followed  by  spasms  of  the  muscles  of  the  limbs, 
with  stiffness.  These  spasms  become  more  pronounced  as 
the  disease  progresses.  The  knee  reflex  is  greatly  exagger- 
ated, and  rectus  clonus  and  ankle  clonus  are  present.  Sensation 
is  undisturbed,  and  the  bladder  and  rectum  are  not  affected. 

Treatment. — Adjustments  should  be  made  wherever  indi- 
cated after  a  careful  spinal  analysis  has  been  made.  Warm 
baths  daily  should  be  given.  Massage  is  also  of  great  value. 
The  patient  should  refrain  from  all  mental  and  physical 
work,  and  the  general  health  should  be  improved  in  every 
possible  way. 

Progressive  Muscular  Atrophy  (Wasting  Palsy) 

Etiology. — Combined  wasting  and  paralysis  of  certain  sets 
of  muscles  is  seen  most  commonly  in  men  between  the  ages 
of  30  and  50  years.  Its  occurrence  is  contributed  to  chiefly 
by  syphilis,  lead  poisoning,  acute  infectious  diseases  and 
exposure. 

Pathology. — There    is    atrophy   and    degeneration    of   the 


DISEASES  OF  NERVOUS  SYSTEM  497 

anterior  columns  of  the  spinal  cord,  and  a  degeneration  of  the 
ganglion  cells.  There  is  a  wasting  of  the  muscular  tissue 
and  a  replacement  thereof  by  fibrous  connective  tissue.  This 
continues  until  the  muscle  is  converted  into  a  fibrous  band 
containing  a  large  number  of  fat  cells. 

Symptoms. — The  disease  commences  very  insidiously. 
There  are  first  fine  contractions  of  the  muscles,  which  are 
very  sensitive  and  respond  to  such  slight  stimulation  as  a 
draught  of  air.  The  disease  process  is  usually  confined  to 
one  or  a  number  of  groups  of  muscles,  most  commonly  those 
of  the  upper  extremities.  The  first  noticeable  symptom  is  a 
gradual  wasting  of  the  muscle,  which  is  accompanied  by  in- 
creasing weakness  of  those  muscles,  together  with  paresthe- 
sia, pallor  and  coldness  of  the  skin  over  them.  The  atrophy 
of  the  muscles  is  so  extreme  that  the  bones  remain  practically 
uncovered  except  by  skin.  V^arious  forms  of  the  disease  are 
recognized,  depending  upon  the  particular  group  of  muscles 
which  is  affected. 

Treatment. — Alake  adjustments  in  those  segments  from 
which  the  affected  groups  of  muscles  derive  their  innervation. 
Electricity  and  massage  are  both  of  value  in  these  cases.  Hot 
baths,  followed  by  brisk  friction  for  about  ten  minutes  are 
also  useful  adjuncts  in  the  treatment.  Rest  and  attention 
to  the  general  health  are  measures  which  should  not  be 
overlooked. 

Ataxic  Paraplegia 

Etiology. — Chronic  degeneration  of  the  lateral  and  poste- 
rior columns  of  the  spinal  cord  occurs  principally  in  persons 
of  advanced  age,  whose  life  has  been  one  of  hardships. 
Among  the  contributing  causes  may  be  mentioned  syphilis, 
heredity,  anemia,  and  various  forms  of  intoxications. 

Pathology. — There  is  a  sclerosis  of  the  posterior  and 
lateral  columns  of  the  spinal  cord  similar  to  that  which  occurs 
in  tabes  dorsalis,  except  that  the  lesions  are  limited  princi- 
pally to  the  dorsal  portion  of  the  spinal  cord,  rather  than 
to  the  dorso-lumbar  section. 

Symptoms. — The  disease  commences  very  gradually,  the 
first  symptom  noted  being  a  loss  of  power  in  the  lower  ex- 
tremities, together  with  pain  and  stiffness.     Ataxia  is  present 


498  SPINAL  ADJUSTMENT 

as  shown  by  the  swaying  when  the  patient  stands  with  the 
feet  close  together,  and  the  tendency  to  fall  when  he  stands 
with  the  eyes  closed.  The  knee-jerk  is  increased.  Spasms 
of  the  lower  limbs  occur.  There  are  no  shooting  pains  nor 
eye  symptoms,  nor  is  sensation  impaired,  as  is  the  case  in 
locomotor  ataxia.  Incontinence  of  urine  and  feces  is,  however, 
frequently  noticed. 

Treatment. — The  treatment  of  this  affection  is,  in  general, 
the  same  as  that  given  in  the  case  of  locomotor  ataxia,  and 
amyotrophic  lateral  sclerosis. 

Hereditary  Ataxia   (Friedrich's  Ataxia) 

Etiology. — This  disease  affects  persons  during  the  first  20 
years  of  life,  and  is  seen  most  commonly  in  families,  which 
indicates  that  it  is  hereditary. 

Patholog}\ — There  is  defective  development  of  the  spinal 
cord,  since  post-mortem  examinations  show  the  cord  to  be 
smaller  than  normal.  There  is  a  degeneration  and  atrophy, 
together  with  disappearance  of  the  ganglia  in  the  posterior 
columns  of  the  spinal  cord. 

Symptoms. — The  characteristic  symptoms  of  this  condi- 
tion are  ataxia,  and  paraplegia,  which  produce  an  uncertain 
gait.  The  speech  is  scanning  and  uncertain.  Vision  is  im- 
paired. Reflexes  are  unchanged  or  diminished.  Sensory 
symptoms  are  never  present.  Scoliosis  and  deformities  of 
the  feet  are  often  noticed. 

Treatment. — The  treatment  given  for  locomotor  ataxia 
is  applicable  in  this  disease. 

Multiple  Sclerosis  (Cerebro-Spinal  Sclerosis;  Disseminated  Sclerosis) 

Etiology. — This  disease  is  seen  between  the  ages  of  15 
and  40  years,  and  is  due  to  injuries.  Sometimes  it  follows 
acute  infectious  diseases,  and  has  also  been  accompanied  by 
a  previous  history  of  syphilis,  tuberculosis  and  malaria. 

Pathology. — Spots  of  sclerosis  are  found  throughout  the 
extent  of  the  brain  and  spinal  cord.  These  spots  vary  in 
size  from  a  pinhead  to  a  nut,  and  consist  of  degenerated  nerve 
tissue  and  connective  tissue.  Pressure  of  the  nodules  upon 
the  nerve  structures  of  cord  result  in  degeneration  thereof. 


DISEASES  OF  NERVOUS  SYSTEM  499 

Symptoms. — The  condition  develops  slowly,  and  the  symp- 
toms indicate  the  location  of  the  lesion.  Characteristic 
symptoms  are  impaired  vision  and  nystagmus,  speech  dis- 
turbances, headache,  vertigo,  and  epileptiform  seizures.  Later 
a  tremor  of  the  extremities  appears,  the  reflexes  are  exagger- 
ated, and  stiffness  and  contracture  of  the  limbs  develop. 
Later  the  gait  becomes  spastic,  and  finally  complete  paralysis 
occurs,  the  legs  remaining  extended  and  rigid. 

Treatment. — Make  adjustments  in  those  segments  which 
control  the  parts  affected.  Useful  adjunct  measures  are 
electricity,  massage,  and  systematic  exercises. 

Syringomyelia 

Etiology. — The  characteristic  feature  of  this  disease  is  the 
occurrence  of  cavities  in  the  substance  of  the  spinal  cord,  the 
exact  mode  of  production  of  which  is  not  definitely  known. 
The  affection  is  seen  during  the  first  half  of  life,  and  follows 
injuries  of  the  cord  most  frequently. 

Pathology. — The  morbid  lesions  are  confined  principally 
to  the  cervical  portion  of  the  spinal  cord.  The  production  of 
the  cavities  has  been  explained  in  two  ways.  The  first  theory 
is  that  there  is  faulty  development  of  the  central  canal  of 
the  cord,  in  which  there  is  only  a  partial  closure  of  the  pri- 
mary central  canal  of  the  cord  in  the  embryo.  The  second 
theory  is  that  the  cavities  are  produced  by  the  degeneration 
and  absorption  of  gliomatous  substance  in  the  substance  of 
the  cord. 

Symptoms. — The  disease  commences  very  slowly,  the  first 
symptom  usually  being  a  diminution  or  absence  of  the  pain 
and  temperature  sense,  while  the  touch  sense  is  intact.  When 
the  anterior  columns  of  the  cord  are  affected,  atrophy  of  the 
muscles  occurs,  and  most  commonly  affects  the  muscles  of 
the  arms  and  shoulders,  being  generally  bilateral.  The  at- 
rophy of  the  muscles  is  accompanied  by  weakness,  and  wiien 
the  weakness  affects  the  muscles  of  the  spinal  column,  scoli- 
osis follows.  In  like  manner  the  skin  is  affected  by  trophic 
changes,  which  may  progress  to  gangrene. 

Treatment. — Make  adjustments  as  indicated  by  the  spinal 
analysis.  Attention  to  the  general  health  and  treatments  of 
symptoms  as  they  arise,  are  required. 


500      -  SPINAL  ADJUSTMENT 

Caisson  Disease 

Etiology. — This  condition  is  seen  in  individuals  who  work 
under  increased  atmospheric  pressure,  such  as  divers,  and 
those  engaged  in  the  construction  of  tunnels,  subways,  and 
the  foundations  of  large  buildings. 

Symptoms. — The  symptoms  generally  occur  when  the  in- 
dividual returns  to  the  surface  atmosphere,  and  include  head- 
ache, dizziness,  ringing  of  the  ears,  and  mild  prostration.  The 
more  severe  symptoms  which  may  follow  are  various  forms 
of  paralysis,  loss  of  sensation,  and  epileptiform  seizures. 

Treatment. — The  essential  treatment  is  prevention,  and 
consists  in  persons  engaged  in  work  of  this  nature  to  return 
to  the  surface  gradually,  so  as  to  accustom  themselves  to  the 
change  in  the  atmospheric  pressure.  Sequelae  should  be 
treated  as  they  arise,  the  treatment  consisting  principally  of 
adjustments,  massage  and  hydro-therapy. 

Diseases  of  the  Peripheral  Nervous  System 
Simple  Neuritis 

Etiology. — The  primary  and  predisposing  cause  of  inflam- 
mation of  the  nerve  trunks  is  impingement  of  the  nerves  by 
a  subluxated  vertebra.  Among  the  principal  contributing 
or  exciting  causes  may  be  mentioned  injuries,  exposure  to 
cold  and  wet,  alcoholism,  gout,  rheumatism,  syphilis, 
lead-poisoning,   and   infectious   diseases. 

Symptoms. — The  characteristic  symptom  of  this  affection 
is  intense  pain  and  tenderness  along  the  cords  of  the  nerve 
and  its  main  branches ;  the  pain  resembles  that  of  a  toothache, 
and  is  increased  by  movement  or  by  pressure.  If  the  nerve, 
in  addition  to  being  sensory,  is  a  motor  nerve,  contraction  and 
spasms  of  the  muscles  occur,  followed  by  partial  paralysis. 
The  muscular  and  temperature  sense  are  very  little  impaired, 
but  the  touch  and  pain  sense  are  decidedly  afifected.  At  times 
degeneration  of  the  nerve  trunk  follows,  and  in  such  cases 
there  is  atrophy  and  degeneration  of  the  muscles  supplied  by 
this  nerve. 

Treatment. — Make  adjustments  in  the  segments  which 
control  the  aiTected  parts,  and  subluxations  will  always  be 
found  affecting  the  nerve.     Accessory  treatment  consists  in 


DISEASES  OF  NERVOUS  SYSTEM  501 

placing  the  part  at  rest,  and  after  the  acute  symptoms  have 
subsided,  electrical  treatments  should  be  given  to  further 
stimulate  the  nerve,  and  to  repair  the  tonicity  of  the  affected 
muscle. 

Multiple  Neuritis 

Etiology. — Inflammation  of  a  number  of  nerves  may  be 
caused  by  a  great  variety  of  poisons,  chief  of  which  are  alco- 
hol, lead  and  arsenic,  and  mercury.  It  also  accompanies 
nearly  all  the  acute  infectious  diseases.  Frequently  it  is  seen 
in  syphilis,  diabetes,  rheumatism,  gout,  and  chorea.  It  is  seen 
in  w^omen  much  more  commonly  than  in  men,  and  occurs 
between  the  ages  of  30  and  50. 

Symptoms. — The  disease  usually  commences  slowly,  and 
runs  a  chronic  course.  The  characteristic  symptoms  of  mul- 
tiple neuritis  due  to  lead  poisoning  are  the  fact  that  it  occurs 
in  chronic  lead  poisoning,  and  that  the  symptoms  of  this  con- 
dition, namely  a  blue  line  on  the  gums,  anemia,  and  lead 
colic  are  present.  The  radial  nerve  is  principally  affected,  and 
wrist-drop  is  a  constant  symptom.  No  sensory  disturbances 
are  present. 

The  characteristic  symptoms  of  multiple  neuritis,  due  to 
alcoholic  poisoning  are  the  facts  that  there  is  always  a  his- 
tory of  chronic  alcoholism :  in  this  form  the  neuritis  is  very 
generally  distributed  over  the  body ;  the  result  of  the  affection 
in  the  lower  extremities  are  foot-drop,  ataxia,  uncertain  gait, 
paralysis  of  the  muscles,  tenderness  of  the  calf  muscles.  The 
disease  is  not  so  severe  in  the  upper  as  in  the  lower  extremi- 
ties, both  of  which  are,  however,  affected  in  every  case. 
Tenderness  of  the  nerve  and  nerve  pain  are  present,  and  occur 
before  paralysis  develops.  All  forms  of  sensory  disturbances 
are  present.  The  reflexes  are  absent  in  the  paralyzed  mus- 
cle, and  edema  of  the  ankles  very  often  occurs.  IMental  dis- 
orders frequently  accompany  this  form  of  multiple  neuritis. 

The  characteristic  symptoms  of  multiple  neuritis  due  to 
arsenic  poisoning  are  marked  gastro-intestinal  disturbances 
for  some  time  preceding  the  actual  occurrence  of  the  inflam- 
mation of  the  nerves.  As  in  alcoholic  neuritis,  the  legs  are 
more  affected  than  the  arms,  though  to  a  greater  degree. 
Various  disturbances  of  sensation,  atrophy  and  paralysis,  and 
pain  are  present. 


502  SPINAL  ADJUSTMENT 

Treatment. — In  all  cases  attention  should  first  be  directed 
to  the  relief  of  the  exciting  cause.  Absolute  rest  in  bed  is 
necessary  and  the  afifected  limb  should  be  wrapped  in  hot 
compresses.  The  diet  should  be  nourishing  and  non-stimulat- 
ing. Adjustment  should  be  made  in  those  segments  control- 
ling the  afifected  parts.  After  the  acute  symptoms  have 
subsided,  electricity  and  massage  and  passive  exercises  should 
be  used. 

Neuralgia 

Etiology. — The  primary  and  predisposing  cause  of  neu- 
ralgia is  a  subluxation  of  a  vertebra  which  produces  an  im- 
pingement of  the  nerve  transmitted  through  the  correspond- 
ing intervertebral  foramen.  The  contributing  or  secondary 
causes  are  exposure  to  cold  and  damp,  injuries  of  the  nerve 
trunks,  reflex  disturbances,  mental  overwork  and  anxiety. 
The  condition  frequently  accompanies  syphilis,  rheumatism, 
gout,  intoxications,  anemia,  and  malaria.  It  is  seen  ordinarily 
in  adult  life,  more  frequently  in  women  than  in  men,  and 
heredity  seems  to  have  some  influence  in  its  production. 

Symptoms.— There  are  a  number  of  varieties  of  neuralgia 
which  are  classified  according  to  their  location.  The  most 
common  forms  of  these  local  neuralgias  are  the  following: 

Trigeminal  Neuralgia,  or  Tic  douloureux,  is  a  neuralgia 
of  the  5th  cranial  nerve,  and  is  one  of  the  most  severe  and 
obstinate  of  all  neuralgias.  Pains  are  intense  and  darting, 
and  unilateral.  Paroxysms  usually  last  for  a  few  minutes, 
followed  by  partial  remissions.  There  are  convulsive  twitch- 
ing of  the  muscles  of  the  side  of  the  face  afifected.  There  is 
tenderness  at  the  supra-orbital  and  infra-orbital  foramina,  and 
along  the  course  of  the  nerve. 

Cervico-occipital  Neuralgia  consists  of  a  sharp,  spasmodic 
pain,  which  may  be  unilateral  of  bilateral,  and  extends  from 
the  top  of  the  head  down  the  neck  as  far  as  the  clavicle,  and 
then  forward  and  upward  to  the  sides  of  the  face.  The  skin 
over  the  afifected  area  may  be  very  sensitive,  contractions  of 
the  cervical  muscles  may  occur.  In  many  of  these  cases  a 
clicking  sound  in  the  back  of  the  neck  is  complained  of. 

Cervico-brachial  Neuralgia  is  a  lancinating  or  burning 
pain,   and  tenderness  along  the   nerves  forming  the  cervical 


DISEASES  OF  NERVOUS  SYSTEM  503 

and  lirachial  plexuses.     There  is  numbness  and  weakness  of 
the  shoulder,  arm,  scapula  and  breast. 

Intercostal  Neuralgia  is  a  paroxysmal  pain  occurring  most 
commonly  in  the  5th  and  6th  intercostal  nerves.  The  condi-* 
tion  is  distinguished  from  pleurisy  by  the  three  characteristic 
points  of  tenderness,  namely,  at  the  exit  of  the  nerve  from 
the  spinal  foramen,  at  the  greatest  covexity  of  the  rib,  and 
at  the  sterno-costal  articulation.  This  form  of  neuralgia  is 
frequently  accompanied  by  herpes  zoster,  or  shingles. 

Lumbo-Abdominal  Neuralgia,  is  a  paroxysmal  pain  of  a 
lancinating  character  along  the  inner  side  of  the  thigh,  the 
hip  and  the  scrotum. 

Sciatica  is  a  paroxysmal  lancinating  pain  along  the  thigh, 
calf,  ankle  and  heel. 

Coccygodynia  is  a  paroxysmal,  boring  pain  experienced 
during  walking  and  sitting  alike,  and  felt  over  the  end  of  the 
spine.  It  is  a  result  commonly  of  perineal  laceration  or  pelvic 
diseases. 

Tarsalgia  is  a  variety  of  neuralgia  which  afifects  the  soles 
of  the  feet,  and  is  seen  in  those  who  are  obliged  to  be  on  their 
feet  a  great  deal  of  the  time.  It  is  frequently  accompanied 
by  flatfoot. 

Treatment. — The  treatment  of  neuralgia  consists  in  adjust- 
ment of  the  vertebrae  corresponding  to  those  spinal  segments 
which  control  the  afifected  parts,  or  from  which  the  nerves 
are  derived.  Accessory  methods  of  treatment  are  the  applica- 
tion of  hot  compresses,  or  dry  heat.  In  all  cases  the  occur- 
rence of  contributing  causes  should  be  carefully  investigated, 
and  corrections  made  as  indicated.  The  general  health  should 
be  given  careful  attention.  Suitable  diet,  baths,  and  exercises 
should  be  prescribed. 

Facial  Paralysis  (Bell's  Palsy) 

Etiology. — Paralysis  of  the  7th  cranial  nerve  is  caused  by 
exposure  to  cold,  disease  or  injury  of  the  middle  ear,  disease 
of  the  nucleus  of  the  7th  nerve,  or  in  the  cortex  or  base  of 
the  brain ;  also  by  rheumatism,  syphilis,  and  infectious 
diseases. 

Symptoms. — The  characteristic  symptoms  of  paralysis  of 
the  facial  muscles  are  want  of  expression,  all  wrinkles  being 


504  SPINAL  ADJUSTMENT 

smoothed  out,  and  the  mouth  is  drooped,  and  drawn  toward 
the  unaffected  side.  The  eye-lids  do  not  cover  the  eye-balls 
entirely;  the  patient  is  unable  to  whistle,  to  show  the  teeth, 
or  to  inflate  the  cheek  of  the  paralyzed  side.  The  mouth  is 
dry,  due  to  a  diminution  in  the  quantity  of  saliva,  and  there 
is  disturbance  of  the  sense  of  taste  of  the  anterior  two-thirds 
of  the  paralyzed  side  of  the  tongue.  In  some  cases  hearing 
is  hyper-acute.     No  sensory  disturbances  are  present. 

Treatment. — Adjust  the  1st  and  4th  cervical  and  the  upper 
dorsal  vertebrae.  In  the  acute  stages  of  the  affection  the 
bowels  should  be  kept  open  and  free  action  of  the  skin  main- 
tained by  daily  hot  baths.  Later,  when  the  acute  symptoms 
have  subsided,  electricity  and  massage  are  useful. 

General  Nervous  Diseases 
Epilepsy 

Etiology. — In  nearly  all  cases  of  epilepsy  a  pronounced 
neurotic  family  history  may  be  obtained.  The  disease  is  seen 
most  commonly  during  the  first  half  of  life,  and  commences 
ordinarily  between  the  ages  of  10  and  20  years.  The  most 
common  exciting  causes  are  any  form  of  peripheral  irritation  ; 
thickening  or  adhesions  of  the  meninges,  mental  worry, 
anxiety,  fear  and  depression,  syphilis,  and  uterine  diseases. 
Frequently  the  condition  can  be  traced  to  an  injury,  and  sub- 
luxation of  the  vertebrae  may  be  the  cause  in  some  cases,  as 
attested  to  by  the  fact  that  adjustments  sometimes  relieve 
the  condition.  In  all  cases  of  epilepsy  constipation  is  a 
constant  feature  and  may  be  an  important  predisposing  cause. 

Symptoms. — Epilepsy  is  classed  in  two  forms :  Petit  Mai, 
in  which  the  disease  is  very  mild,  and  Grand  Mai,  in  which 
the  attacks  are  severe. 

The  attack  comes  on  suddenly  and  without  forewarning, 
the  patient  falling  where  he  stands,  and  being  unable  to  make 
any  efforts  to  protect  himself.  Sometimes  a  characteristic 
cry  is  uttered  before  the  patient  falls.  Convulsions  then  occur, 
which  at  first  are  tonic  and  later  become  clonic.  During  the 
attacks  there  may  be  frothing  of  the  mouth,  due  to  the  forci- 
ble passage  of  air  through  the  narrow  opening  between  the 
teeth,  and  the  tongue  may  be  bitten.     The  convulsions  con- 


DISEASES  OF  NERVOUS  SYSTEM  505 

tiniie  for  several  minutes,  and  are  followed  by  unconscious- 
ness. During  the  stage  of  coma  the  face  becomes  cyanotic, 
and  turned  to  one  side.  The  pupils  are  dilated,  and  do  not 
react.  The  pulse  is  increased  in  frequency;  the  respiration 
is  first  diminished  and  then  becomes  snoring;  the  temperature 
is  slightly  raised. 

Treatment. — Every  case  of  epilepsy  should  be  carefully 
studied  w^ith  a  view  to  determining  the  exact  cause.  Some 
cases  respond  to  spinal  adjustment,  a  complete  cure  result- 
ing; others  are  only  improved,  while  still  others  are  not  af- 
fected at  all.  In  those  cases  in  which  the  disease  is  due  to 
some  peripheral  irritation,  correction  of  this  exciting  cause 
will  help.  A  careful  spinal  analysis  should  be  made  in  every 
instance,  and  the  subluxations  which  are  found  should  be 
corrected.  Adjustment  of  the  atlas  and  axis,  the  4th  cervical 
and  the  upper  dorsal  and  upper  lumbar  vertebrae  are  espe- 
cially indicated.  Rectal  dilatation  has  also  been  recommended 
in  these  cases.  The  general  health  should  receive  attention, 
and  proper  diet  of  a  non-stimulating  character  prescribed. 
The  hot  magnesium  sulphate  baths  daily  are  also  beneficial 
measures  during  the  intervals  between  the  paroxysms.  If 
the  patient  is  seen  during  an  attack,  the  clothing  should  be 
loosened,  an  object  should  be  placed  between  the  teeth  to 
prevent  biting  of  the  tongue,  and  he  should  be  left  in  a 
comfortable  position. 

Hysteria 

Etiology. — This  disease  is  best  defined  by  IMobius  as  be- 
ing "A  state  in  which  ideas  control  the  body,  to  produce  mor- 
bid changes  in  its  function"  (Osier).  It  is  a  condition  peculiar 
to  our  present  civilization,  and  is  seen  in  young  girls,  unmar- 
ried women,  widows,  and  childless  married  women.  Mani- 
festations are  seen  most  commonly  during  menstruation,  and 
during  the  menopause.  Exciting  causes  are  powerful  emo- 
tions, especially  those  of  a  painful  nature,  such  as  fear,  sorrow, 
etc.  Predisposing  causes  are  faulty  innervation  due  to  a 
multiplicity  of  spinal  lesions,  in  connection  with  injuries, 
infectious  fevers,  mercury,  tobacco,  and  all  forms  of  toxic 
irritants. 

Symptoms. — The  disease  is  seen  in  two  forms :  Hysteria 


506  '^"  SPINAL  ADJUSTMENT 

minor  and  hysteria  major.  Hysteria  minor  generally  attacks 
girls  or  young  women  who  are  of  an  emotional  nature.  The 
first  symptoms  which  manifest  themselves  are  a  morbid 
sensitiveness,  inability  to  control  the  emotions,  great  depres- 
sion of  mind,  nervousness,  etc.  The  patient  becomes  alarmed 
at  trifles,  and  as  a  rule  there  are  headaches,  and  pains  along 
the  spine.  There  may  also  be  attacks  of  vomiting,  and  some- 
times the  hysteria  is  so  severe  as  almost  to  amount  to  actual 
delirium.  In  aggravated  cases  and  when  the  patient  is  of 
an  intensely  emotional  nature,  there  may  be  present  a  mental 
condition  in  which  the  patient  says  and  does  things  of  which 
afterwards  there  is  no  consciousness.  The  "cries"  emitted 
during  the  hysterial  crises  are  sufficient  to  distinguish  it  from 
neurasthenia  or  mere  nervousness.  Unless  properly  treated, 
this  minor  form  of  the  malady  may  be  perpetuated  and  de- 
velop into  the  major  form.  Between  the  paroxysms  of  hys- 
teria major,  there  are  present  contractures,  paralysis,  tremors 
and  anesthesia,  as  well  as  a  disturbance  in  the  mental  func- 
tions. There  are  also  attacks  of  vomiting,  severe  pains, 
hysterical  coughing,  sneezing,  and  labored  respiration.  The 
patient  loses  all  control  of  the  emotions,  and  laughs  and  cries 
excessively  and  without  any  reason.  Very  frequently  there 
are  paroxysms  of  anger,  with  great  excitation,  and  accompany- 
ing these  manifestations  there  is  a  feeling  as  if  there  were 
some  substance  in  the  throat  producing  a  feeling  of  squeez- 
ing or  compression  (Globus  Hystericus).  An  excessive 
discharge  of  urine  follows  the  crisis.  Convulsions  occur  only 
in  the  major  form  of  hysteria;  it  is  really  epileptical  in  nature, 
as  its  name  implies  (hystero-epileptic).  These  attacks  are 
quite  severe,  and  manifest  themselves  as  follows :  The  patient 
suddenly  falls,  and  the  legs  and  arms  are  thrown  about  in 
a  wild,  irregular  manner ;  the  head  is  rolled  from  side  to  side ; 
the  body  is  rolled  from  side  to  side,  and  in  very  severe  attacks 
the  patient  flexes  the  fingers  and  extends  the  feet ;  there  are 
also  abnormal  conditions  of  the  eyeballs  and  the  eyes  are  gen- 
erally closed.  During  the  seizure  the  patient  may  bite  the 
lips,  but  does  not,  as  in  true  epilepsy,  bite  the  tongue,  nor 
do  herself  any  serious  injury  during  the  attacks.  The  at- 
tacks may  last  from  half  an  hour  to  several  hours.  In  some 
cases  of  hysterical  convulsions  there  may  be  merely  a  shaking 


DISEASES  OF  NERVOUS  SYSTEM  507 

of  the  body,  as  in  a  chill ;  in  others,  the  attacks  may  manifest 
themselves  in  a  rigidity  and  rhythmical  swaying  of  the  body, 
movements  of  the  arms,  and  incoherent  noises.  During  these 
attacks  the  patient  is,  in  a  great  measure,  conscious  of  her 
surroundings,  and  very  often  can  be  beneficially  acted  upon 
by  suggestions  from  those  around.  In  the  case  of  children, 
the  attacks  are  often  accompanied  by  peculiar  noises,,  the 
patient  imitating  the  bark  of  a  dog,  and  similar  sounds. 

Besides  these  motorial  symptoms,  there  are  also  sensory 
symptoms,  such  as  hyperesthesia  of  the  skin  and  the  mucous 
membranes,  and  also  disturbances  in  the  organs  of  special 
sense.  The  permanent  optic  disturbances  of  hysteria  are  loss 
of  color  sense,  which  is  either  entirely  lost  or  at  least  greatly 
impaired ;  the  vision  is  also  impaired,  and  in  some  cases  eye- 
sight is  totally  lost.  The  hearing  is  also  afifected ;  in  some 
cases  hearing  by  aerial  conduction  may  be  normal,  while 
hearing  by  bone  conduction  may  be  greatly  impaired  or  en- 
tirely lost.  There  may  also  result  abnormalities  in  the  sense 
of  taste  and  also  in  that  of  smell.  Although  true  neuralgia 
is  not  often  associated  with  hysteria,  yet  hyperesthesia  and 
different  kinds  of  pains  are  of  common  occurrence.  In 
women  the  most  prominent  hyperesthetic  points  are  over  the 
region  of  the  ovaries,  and  in  men  on  the  corresponding  area 
(the  scrotum).  The  motor  symptoms  which  are  associated 
with  hysteria  are  contractures,  tremors,  paralyses,  and  choreic 
and  ataxic  movements.  These  paralyses  may  be  either  hemi- 
plegic,  monoplegic,  or  paraplegic.  Hemiplegia,  associated 
with  hysteria,  can  be  easily  distinguished  from  the  hemiplegia 
due  to  organic  disease,  by  the  gait  of  the  patient.  In  true 
hemiplegia,  or  that  form  which  is  the  result  of  organic  dis- 
ease, the  patient  invariably  swings  his  leg,  while  in  the 
hysterical  he  drags  the  afifected  leg  after  him.  Hysterical 
hemiplegia  is  usually  accompanied  by  anesthesia  of  the  af- 
fected region.  Paraplegia  is  not  uncommon  among  the 
permanent  effects  of  hysteria,  and  may  or  may  not  be  accom- 
panied by  pain  of  a  very  severe  nature.  Permanent 
disturbances  of  the  sphincters  is  not  common,  and  when  it 
does  occur,  can  generally  be  traced  to  some  other  complicated 
conditions.  There  is  another  peculiar  condition  of  frequent 
occurrence    in    the    interparoxysmal    stage    of    hysteria,    and 


508  SPINAL  ADJUSTMENT 

which  is  known  as  amyosthenia,  or  a  temporary  loss  of  power 
in  the  arm  or  leg.  It  is  not  confined  to  a  single  group  of 
muscles,  but  affects  the  entire  member. 

Treatment. — Adjust  the  atlas,  axis,  upper  dorsal  and  lum- 
bar vertebrae.  A  cold  douche  to  the  abdomen  or  spine  will 
frequently  terminate  a  paroxysm.  Further  than  this  nothing 
need  be  done  for  the  hysterical  attack.  The  treatment  of 
patients,  suffering  from  hysteria  must  be  confined  in  the  first 
place  to  an  attempt  to  discover  the  cause  of  the  condition. 
It  is  very  often  difficult  to  do  this,  and  hypnotism  has  been 
suggested  as  a  means  of  eliciting  the  desired  information. 
Suggestive  therapeutics  are  probably  the  best  method  in  cases 
of  this  kind,  although  their  effects  are  usually  temporary  only. 
Daily  tepid  baths  are  useful  not  only  for  their  effect  in  im- 
proving the  general  health,  but  also  for  their  sedative  affect. 
Attention  to  diet,  exercise,  and  general  hygienic  measures  is 
necessary. 

Neurasthenia 

Etiology. — In  every  case  of  neurasthenia  a  great  diversity 
of  spinal  lesions  are  constantly  present.  Contributing  causes 
are  a  neurotic  temperament,  overwork,  both  mental  and 
physical,  sexual  excesses,  and  chronic  diseases.  Heredity 
plays  an  important  part  in  the  production  of  this  condition, 
and  excessive  use  of  alcohol  and  tobacco  also  are  a 
contributing  cause. 

Symptoms. — The  characteristic  symptoms  of  true  neu- 
rasthenia are  insomnia,  general  weakness,  restlessness,  inabil- 
ity to  concentrate  the  mind,  or  do  physical  work  of  any  kind, 
increase  of  the  sense  of  pain,  headaches,  and  expression  of 
anxiety  on  the  face,  imaginary  ailments  of  all  kinds,  and 
exaggerated  reflexes. 

Treatment. — A  careful  spinal  analysis  should  be  made,  and 
all  subluxations  found  should  be  corrected.  Special  attention 
should  be  paid  to  the  1st,  2nd  and  4th  cervical,  and  the  4th 
and  6th  dorsal,  and  the  2nd  lumbar  vertebrae.  Adjunct  meas- 
ures consist  chiefly  in  procuring  for  the  patient  a  change  in 
surroundings,  rest,  good  diet,  and  attention  to  the  mental 
condition.  Much  can  be  accomplished  by  attention  to  the 
last  mentioned   condition   through   suggestion  to  the  patient 


DISEASES  OF  NERVOUS  SYSTEM  509 

of  the  Heedlessness  of  their  fears,  and  encouraging  them.  The 
causes  which  have  brought  on  the  condition  should  be  re- 
moved. Rectal  dilatation  and  daily  tepid  baths  are  very 
beneficial  in  this  condition.  Electricity  and  massage  are  also 
very  useful  measures. 

Chorea    (St.   Vitus'   Dance) 

Etiolog}^ — Chorea  is  seen  most  commonly  in  children, 
and  girls  are  afifected  more  often  than  boys.  The  primary 
and  predisposing  cause  in  the  large  proportion  of  cases  is  a 
lowering  of  the  general  vitality,  due  to  spinal  lesions.  Con- 
tributing causes  are  fright,  overstudy,  lack  of  fresh  air  and 
exercise,  auto-intoxication,  and  sometimes  following  infection. 

Symptoms. — The  characteristic  symptoms  of  chorea  are 
involuntary,  jerky,  spasmodic  irregular  movements,  of  vari- 
ous groups  of  muscles,  usually  affecting  the  arm  first.  The 
muscular  twitchings  in  the  face  and  tongue  give  rise  to  a 
great  variety  of  facial  grimaces.  The  overactivity  of  the  mus- 
cles finally  renders  them  weak  and  partially  paralyzed.  The 
memory  is  affected;  there  is  irritability,  and  violent  temper 
may  be  shown  at  times.  Diseases  of  the  heart,  especially 
valvular  lesions  and  endocarditis  are  common  in  this  affection. 

Treatment. — The  first  essential  in  the  treatment  consists 
in  removing  the  cause  whenever  it  can  be  found.  If  the  child 
is  in  a  poor  state  of  general  health,  measures  should  be  taken 
towards  improving  the  health.  The  bowels  should  be  regu- 
lated by  exercise  and  massage,  a  generous  diet  should  be  pre- 
scribed, and  the  child  should  be  kept  in  the  fresh  air  as  much 
as  possible.  In  all  cases  the  heart  should  receive  careful  at- 
tention, and  unless  it  is  affected,  the  child  should  be  encour- 
aged to  take  a  great  deal  of  exercise.  Cold  sponging  every 
morning  and  evening  is  also  a  very  useful  measure  in  this 
condition.  Rectal  dilatation  has  been  used  with  good  success 
in  the  treatment  of  chorea  also.  The  classical  treatment  of 
this  condition  is  adjustment  of  the  1st  cervical,  the  3rd  and 
6th  dorsal,  and  the  lumbar  vertebrae.  Other  subluxations 
may,  however,  exist,  and  a  careful  spinal  analysis  should  be 
made  in  all  cases.  In  a  large  percentage  of  cases,  spinal 
adjustment  alone  is  effective  in  curing  this  condition  in  a  very 
short  time. 


510  SPINAL  ADJUSTMENT 

Tetany 

Etiology. — This  disease  is  primarily  due  to  aggravated 
subluxations,  such  as  those  produced  by  traumatism.  Con- 
tributing causes  are  chiefly  an  insufficient  function  of  the 
parathyroid  gland,  emotion,  hysteria,  and  following  some  of 
the  infectious  fevers.  It  is  seen  most  commonly  in  young 
adults  of  a  nervous  temperament,  and  in  children  suffering 
from  rickets. 

Symptoms. — The  characteristic  symptoms  of  this  affection 
are  spasmodic  contractions  of  the  muscles,  closely  resembling 
epilepsy,  during  which  the  hands  are  strongly  flexed,  the  arms 
are  drawn  upward,  with  the  elbows  flexed,  and  the  legs  mark- 
edly extended.  These  paroxysms  last  from  a  few  minutes 
to  a  number  of  hours.  They  may  occur  once  an  hour,  or  an 
entire  day  may  intervene  between  them. 

Treatment. — A  careful  spinal  analysis  should  be  made, 
and  subluxations  corrected  wherever  found,  paying  especial 
attention  to  the  segments  controlling  the  regions  which  are 
affected  by  the  spasmodic  contraction.  The  general  health 
of  the  patient  should  receive  careful  attention.  Cold  com- 
presses to  the  spine,  several  times  a  day,  are  a  useful  adjunct 
measure. 

Paralysis  Agitans  (Shaking  Palsy) 

Etiolog}^ — This  disease  is  seen  most  commonly  in  women, 
after  the  age  of  50. 

Symptoms. — The  onset  is  gradual,  and  the  first  symptom 
noted  is  a  tremor  in  one  of  the  hands,  especially  the  right  one, 
following  which  the  arm  and  leg  of  the  same  side  are  affected. 
The  limbs  of  the  other  side  then  become  affected  in  the  same 
order,  and  the  tremor  finally  becomes  general.  The  tremor 
is  a  slow,  rythmic  oscillating  movement,  and  the  attitude  of 
the  hand  has  been  compared  to  pill-rolling.  There  is  a  gen- 
eral rigidity  of  the  muscles  which  is  shown  by  the  stolid, 
mask-like  expression  of  the  face,  and  by  the  peculiar  gait, 
which  results  from  the  stiffening  of  the  muscles  of  the  entire 
body,  so  that  the  trunk  is  bent  forward,  and  the  body  moves 
slowly,  as  though  composed  of  one  piece.  The  sensations 
are  not  disturbed,  as  a  result,  although  there  may  be 
sensations  of  heat  and  burning  at  times. 


DISEASES  OF  NERVOUS  SYSTEM  511 

Treatment. — Adjustments  should  be  made  in  those  seg- 
ments from  which  the  innervation  of  the  parts  affected  is 
derived.  Spinal  traction  is  also  a  very  useful  measure  in 
these  cases.  Attention  to  the  general  health  is  necessary  and 
mental  and  physical  exertion  should  be  prohibited. 

Occupation  Neuroses 

Etiolog}^ — Pain  and  cramps  of  certain  groups  of  muscles 
as  a  result  of  over-use,  are  seen  most  commonly  in  persons 
of  a  neurotic  history.  The  most  common  example  is  Writer's 
cramp. 

Symptoms. — There  is  first  a  stiffness  of  the  affected  mus- 
cles, followed  by  a  feeling  of  weight  and  weakness,  and  lastly 
the  development  of  spasmodic  cramps  and  contraction.  There 
may  be  paresis  and  atrophy  of  the  muscles  late  in  the 
condition. 

Treatment. — In  all  these  cases  the  affection  soon  produces 
reflex  subluxations  in  those  segments  from  which  its  inner- 
vation is  derived,  and  subluxations  should  be  corrected.  The 
affected  members  should  be  placed  at  rest,  and  general  rest 
of  the  patient  is  also  advisable.  During  this  time  he  should 
be  placed  upon  a  liquid  diet,  and  attention  given  to  the  neu- 
rotic element  of  the  case.  Later,  friction,  massage,  electricity 
and  passive  movements  are  useful  measures  of  treatment. 

Mental  Diseases 

For  a  description  of  mental  diseases,  the  reader  is  referred 
to  works  on  Psychiatry.  Few  of  these  diseases  are  amenable 
to  treatment  of  any  kind,  although  there  are  cases  reported 
in  which  adjustments  relieved  mental  aberration,  but  whether 
it  was  a  true  insanity  or  not  is  questionable.  There  are  also 
cases  on  record,  in  which  rectal  dilatation  was  eff'ective  in 
restoring  normal  mentality.  It  must  be  remembered  that 
certain  cases  of  insanity  tend  toward  a  spontaneous  cure,  and 
whether  anything  that  was  done  for  their  relief  proved  eff'ec- 
tive or  not,  is  consequently  open  to  question.  In  the  author's 
opinion,  a  true,  well-developed  case  of  insanity  is  incurable. 
There  is,  however,  in  this,  a  fertile  field  for  valuable  research 
work,  and  it  is  to  be  hoped  that  the  future  will  bring  to  light 
positive  evidence  of  restoration  of  the  mental  faculties  by 
spinal   adjustments. 


CHAPTER  X 

Diseases  of  the  Blood  and  Ductless  Glands 

Diseases  of  the  Blood 
Anemia 

Etiology. — The  primary  cause  of  this  disease  is  disturbed 
innervation  of  the  blood-forming  organs,  as  a  result  of  spinal 
lesions  which  are  reflexly  produced  through  various  predis- 
posing causes,  among  which  may  be  mentioned  the  following : 
Hemorrhage,  discharges,  imperfect  nutrition,  excessive  nurs- 
ing, chronic  intestinal  catarrh,  wasting  diseases,  unhygienic 
surroundings,  deficient  food,  excessive  mental  and  physical 
work,  and  pregnancy. 

Pathology. — The  blood  is  light  in  color,  owing  to  the  re- 
duction in  the  amount  of  hemoglobin  and  in  the  number  of 
red  corpuscles.  It  is  also  considered  by  some  that  coagulation 
is  slow. 

Symptoms. — The  characteristic  symptom  of  secondary 
anemia  is  the  proportion  of  decrease  in  the  number  of  red 
corpuscles  to  the  diminution  in  the  amount  of  hemoglobin. 
Other  symptoms  present  are  pallor  of  the  skin  and  mucous 
membranes ;  malaise ;  loss  of  flesh  and  strength ;  headache ; 
irritability,  vertigo,  fainting,  hysteria,  and  convulsive  attacks ; 
anorexia,  nausea  and  vomiting ;  constipation  or  diarrhea ;  low 
blood  pressure ;  rapid  heart  action ;  rapid  respiration  and 
dyspnea ;  edema  of  the  ankles ;  cold  hands  and  feet ;  rapid  and 
feeble  pulse. 

Treatment. — The  first  essential  in  the  treatment  of  secon- 
dary anemia  is  the  removal  of  the  cause.  In  connection 
therewith  a  nutritious  diet,  exercise,  fresh  air,  and  sunlight, 
and  rest  should  be  prescribed.  Make  adjustments  as  indi- 
cated in  the  5th  dorsal  region,  for  stimulation  of  the  blood- 
forming  organs,  and  concussion  of  the  10th  dorsal  vertebra 
for  the  same  reason.  Treat  the  cause  which  may  be  present 
in  each  individual  case,  and  attend  to  the  symptoms  as  they 
arise. 

512 


DISEASES  OF  BLOOD  AND  DUCTLESS  GLANDS  513 

Chlorosis  (Green  Sickness) 

Etiology. — The  primary  cause  of  this  disease  is  subluxa- 
tions, which  interfere  with  the  conduction  of  the  nerve 
impulses  necessary  to  the  functional  activity  of  the  blood- 
forming  organs.  Contributing  causes  are  overwork,  impure 
air,  improper  food,  puberty,  female  sex,  menstrual  disorders, 
heredity,  change  of  climate,  and  constipation. 

Pathology. — The  decrease  in  the  number  of  red  blood 
corpuscles  is  very  slight,  but  there  is  a  decided  decrease  in 
the  amount  of  hemoglobin.  There  is  very  little  loss  in  weight. 
No  morbid  changes  in  the  bone  marrow,  lymphatic  glands, 
or  spleen  are  present. 

Symptoms. — The  characteristic  symptom  of  this  condition 
is  a  greenish  yellow  tint  of  the  skin.  Other  symptoms  pres- 
ent are  edema  of  the  ankles  and  eyelids,  palpitation  of  the 
heart,  faintness,  ringing  in  the  ears,  murmurs  in  connection 
with  the  heart  sounds,  dyspnea,  cold  hands  and  feet,  digestive 
disturbances,  headache,  and  menstrual  disorders. 

Treatment. — Adjust  the  1st  cervical  and  the  middle  dorsal 
vertebrae.  Make  any  other  adjustments  which  may  be  indi- 
cated after  a  careful  spinal  analysis  has  been  made.  Hygienic 
measures  are  an  essential  in  the  treatment  of  this  condition. 
The  bowels,  kidneys  and  skin  should  be  kept  well  regulated. 
Concussion  of  the  10th  thoracic  vertebra.  Rectal  dilatation. 
Well  regulated  exercises.  Careful  attention  to  the  diet,  which 
should  be  highly  nutritious.  Beyond  this  the  treatment  should 
be  directed  to  the  correction  of  any  causes,  and  symptoms 
should  be  taken  care  of  as  they  arise. 

Pernicious  Anemia 

Etiology. — The  primary  cause  of  this  disease  is  a  profound 
disturbance  in  the  innervation  of  the  blood-forming  organs, 
especially  the  bone-marrow.  Among  the  predisposing  causes 
may  be  mentioned  syphilis,  pregnancy,  mental  worry  and 
anxiety. 

Pathology. — The  blood  is  thin,  pale  and  scanty.  The  red 
corpuscles  are  diminished  in  number  and  in  the  quality  of 
their  hemoglobin,  and  show  changes  in  their  form.  There 
is  no  increase  in  the  white  cells.     The  bone  marrow  is  mark- 


514  SPINAL  ADJUSTMENT 

edly  changed  in  character.  Various  organs  and  muscles 
degenerate.  There  is  not  much  emaciation,  but  there  is 
present  extreme  weakness. 

The  leading  symptoms  are  a  slow  onset,  with  pallor  of  the 
skin,  dyspnea  on  exertion,  increasing  weakness,  edema  of 
the  ankles  or  eyes,  palpitation  of  the  heart,  a  soft,  feeble  pulse, 
hemic  murmurs,  and  finally  prostration  and  stupor  develop. 
The  number  of  red  blood  corpuscles  is  increasingly  dimin- 
ished, but  there  is  not  a  corresponding  diminution  in  the 
amount  of  hemoglobin.  The  size,  and  shape  of  the  red  blood 
corpuscles  is  very  much  changed,  and  macrocytes.  poikilo- 
cytes,  megalocytes.  and  microcytes  are  present,  together  with 
a  diminution  in  the  number  of  leucocytes. 

Treatment. — A  careful  spinal  analysis  should  be  made, 
and  adjustments  given  as  indicated.  Rest  in  bed  is  indicated 
in  all  cases.  Fresh  air,  nutritious  food,  salt  baths  and  other 
hygienic  measures  should  be  employed. 

Leukemia 

Etiology. — The  cause  of  this  disease  is  rather  uncertain, 
but  it  is  due  primarily  to  a  grave  functional  disturbance  in 
the  blood-forming  organs,  the  underlying  basis  of  which  is  a 
marked  derangement  of  the  nervous  system. 

Pathology. — The  disease  occurs  in  two  forms,  first  lym- 
phatic leukemia ;  second,  spleno-medullary,  or  myelogenous 
leukemia.  In  both  cases  the  white  corpuscles  are  greatly  in- 
creased in  number.  In  the  lymphatic  form  the  lymph  glands 
are  moderately  enlarged.  In  spleno-medullary  leukemia  the 
spleen  and  liver  are  increased  in  size  in  over  half  the  cases, 
and  the  bone  marrow  is  changed. 

In  the  spleno-medullary  form  of  leukemia  the  red  cells 
are  greatly  decreased  in  number,  while  the  white  corpuscles 
are  markedly  increased,  the  myelocytes  being  in  excess  of  all 
other  forms  of  white  corpuscles  combined.  In  the  lymphatic 
form,  however,  the  myelocytes  are  diminished  in  number, 
while  the  lymphocytes  constitute  nearly  90  per  cent  of  the 
total  number  of  leucocytes  present. 

Symptoms. — In  the  lymphatic  form  the  glands  are  en- 
larged ;  in  the  spleno-medullary  form  the  spleen  is  markedly 
increased  in  size.     In  most  varieties  the  disease  commences 


DISEASES  OF  BLOOD  AND  DUCTLESS  GLANDS  515 

gradually,  and  the  symptoms  are  similar  to  those  of  pernicious 
anemia. 

Treatment. — The  same  as  that  of  pernicious  anemia. 

Hodgkin's   Disease    (Pseudo-Leukemia) 

Etiology. — No  definite  cause  of  this  disease  is  known.  It 
is  very  likely  due  to  a  deep-seated  disturbance  in  the 
sympathetic  nervous  system. 

Pathology. — "A  hyperplasia  of  the  lymph  glands  interfer- 
ing more  or  less  with  their  function.  The  enlargement  may 
be  confined  to  one  isolated  gland,  or  a  number  may  be  af- 
fected in  different  portions  of  the  body,  or  a  number  in  one 
location  may  be  simultaneously  afifected,  causing  a  tumor 
varying  in  size  from  an  tgg  to  an  orange,  or  even  larger.  The 
spleen  and  liver  are  involved  in  two-thirds  of  the  cases.  The 
marrow  of  the  long  bones  may  be  converted  into  a  rich  lym- 
phoid tissue."  (Osier.)  ''The  red  blood  corpuscles  are  de- 
creased in  number,  and  altered  in  size  and  shape ;  the  white 
blood  corpuscles  may  be  slightly  increased  in  number,  but 
there  is  no  approximation  to  anything  like  true  leukemia." 
(Hughes.) 

Symptoms.— The  disease  commences  very  gradually,  the 
first  symptom  noticed  being  an  enlargement  of  the  lymph 
glands  in  the  neck,  after  which  all  the  glands  in  the  body 
become  afifected.  Anemia  then  develops,  and  becomes  pro- 
gressively worse.  The  symptoms  of  leukemia  then  follow. 
The  number  of  leucocytes  is  very  little  increased. 

Treatment.- — ^The  treatment  is  the  same  as  that  of 
pernicious  anemia. 

Addison's  Disease 

Etiology. — This  disease  occurs  most  commonly  in  men 
from  the  ages  of  30  to  50  years.  It  is  due  to  some  destructive 
process  in  the  suprarenal  glands,  which  acts  by  virtue  of  a 
disturbance  in  the  integrity  of  the  gland,  induced  by  faulty 
innervation. 

Pathology. — The  most  common  destructive  process  in  the 
gland  which  occurs  when  their  innervation  is  withdrawn,  is 
tuberculosis ;  inflammation,  atrophy  or  malignant  disease  may 
also  be  contributing  causes.    Sometimes  no  destructive  lesion 


516  SPINAL  ADJUSTMENT 

of  the  suprarenal  capsule  is  present,  but  the  disease  is 
occasioned  by  pressure  upon  the  semilunar  ganglion. 

Symptoms. — The  disease  commences  very  slowly,  with 
a  feeling  of  malaise,  gastrointestinal  disorders,  dyspnea,  pal- 
pitation of  the  heart,  and  dizziness.  The  skin  first  becomes 
pale,  and  finally  changes  to  a  bronze  color.  Similar  changes 
in  the  color  occur  on  the  mucous  membrane  of  the  mouth. 

Treatment. — Adjust  the  4th  cervical  and  the  9th  dorsal 
vertebrae.     Otherwise  the  treatment  is  symptomatic. 

Goitre 

Etiology. — The  primary  cause  of  this  disease  is  a  sublux- 
ation in  the  cervical  region  of  the  spinal  column,  which,  by 
impinging  the  nerves  that  supply  the  thyroid  gland,  cause 
changes  in  its  functional  activity,  and  organic  integrity. 

Pathology. — The  enlargement  of  the  thyroid  gland  which 
is  present  may  be  either  parenchymatous,  interstitial,  cystic 
or  vascular. 

Symptoms. — There  is  a  gradual  enlargement  of  one  of  the 
lobes,  or  both  the  lobes  and  isthmus  of  the  thyroid  gland.  The 
enlargement  is  painless.  No  symptoms  are  present  unless  the 
growth  is  large  enough  to  cause  pressure  symptoms,  by  en- 
croaching upon  the  trachea,  or  by  pressing  upon  vessels  and 
nerves. 

Treatment. — Adjust  the  4th,  5th  and  6th  cervical  vertebrae, 
according  to  the  findings  elicited  upon  a  careful  spinal  analy- 
sis. Massage  of  the  gland  is  sometimes  useful,  while  in 
other  cases  it  seems  to  cause  an  increase  in  the  size  of  the 
gland.  Hot  magnesium  sulphate  compresses  over  the  gland 
have  proven  of  value  in  some  cases.  Another  valuable  ad- 
junct measure  of  treatment  is  the  Violet  ray.  Electrical  treat- 
ments are  also  of  value  in  such  cases. 

Exophthalmic   Goitre 

Etiology. — This  disease  is  due  primarily  to  a  perverted 
function,  namely  excessive  activity  of  the  thyroid  gland,  which 
is  induced  by  an  irritable  condition  of  the  nerves  which  supply 
the  thyroid  gland,  as  a  result  of  impingement  by  subluxated 
vertebrae  in  the  mid-cervical  region.     It  is  seen  more  com- 


DISEASES  OF  BLOOD  AND  DUCTLESS  GLANDS  517 

monly  in  women  than  in  men,  and  is  caused  often  by  anemia 
and  strong-  mental  emotions. 

Symptoms. — The  characteristic  symptoms  of  this  disease 
are  exophthalmos,  a  fibrillary  tremor  of  the  hand,  tachycardia, 
and  enlargement  of  the  thyroid  gland.  The  disease  com- 
mences insiduously,  and  runs  a  chronic  course,  or  it  may  be 
acute.  Widening  of  the  angle  between  the  eyelids  is  present, 
and  is  known  as  Stellwag's  sign.  When  the  eyeball  is  turned 
down  and  the  upper  lid  does  not  follow  it,  exophthalmos  is  in- 
dicated, and  this  is  known  as  Graefe's  sign.  Among  other 
symptoms  present  may  be  mentioned  profuse  perspiration, 
pigmentation  of  the  skin,  gastro-intestinal  disturlpances, 
anemia,  glycosuria,  albuminuria  and  mental  depression. 

Treatment. — Adjust  the  4th,  5th  or  6th  cervical  vertebra, 
as  indicated  by  the  spinal  analysis.  These  adjustments  are 
made  for  their  direct  effect  upon  the  innervation  of  the  thyroid 
gland  itself;  in  addition  thereto,  adjust  the  4th  dorsal  vertebra 
for  its  effect  upon  the  heart.  Concussion  over  the  7th  cervical 
to  increase  the  force  of  the  heart  action,  and  of  the  2nd  dorsal 
vertebra  to  inhibit  and  regulate  its  action.  Much  is  claimed 
for  Epsom  salt  baths,  and  these  should  be  given  a  thorough 
trial.  Electricity  is  useful  in  some  cases.  General  hygienic 
measures  should  be  enforced. 

Myxedema 

Etiology. — This  disease  occurs  in  two  forms.  (1)  Cretin- 
ism, which  is  a  congenital  absence  of  the  thyroid  gland ; 
(2)  Myxedema  of  adults,  which  is  atrophy  of  the  gland  fol- 
lowing withdrawal  of  its  nerve  supply.  The  disease  develops 
about  middle  life  and  is  more  common  in  women  than  in  men. 
It  may  follow  total  extirpation  of  the  thyroid  gland,  in  which 
case  it  is  known  as  Operative  Myxedema. 

Pathology. — The  lesion  characteristic  of  myxedema  is 
atrophy  of  the  thyroid  gland  which  is  sometimes  more  evident 
in  one  lobe  than  in  the  other. 

Symptoms. — In  the  myxedema  of  adults  the  disease  com- 
mences gradually ;  the  countenance  is  expressionless,  the  lips 
are  thick,  the  nostrils  are  wide  and  large.  The  hair  is  dry; 
mentality  is  deficient;  temperature  is  subnormal.  In  cretin- 
ism the  symptoms  are  noticeable  after  the  child  is  about  six 


518  SPINAL  ADJUSTMENT 

months  old,  when  it  becomes  apparent  that  its  growth  and 
mentality  are  stunted.  Other  characteristic  features  are  the 
dry  skin,  large  tongue,  and  the  hair  is  thin.  "About  the  sec- 
ond year  the  face  is  large,  bloated  and  waxy  appearing;  eye- 
lids puffy;  nose  depressed  and  flat;  teeth  decay;  abdomen 
swollen ;  legs  short ;  muscular  weakness ;  and  large  pads  of 
fat  in  the  supra-clavicular  region.  Idiocy  is  the  rule.  Those 
that  survive  youth,  grow  up  dwarfed  with  short  limbs,  and 
enormous  enlargement  of  the  articulation."  (Kohberger). 

Treatment. — Make  the  same  adjustments  as  for  exoph- 
thalmic goitre.  Warm  climate.  Consultation  is  advisable  in 
these  cases. 


CHAPTER  XI 

Diseases  of  the  Genito-Urinary  System 
Congestion  of  the  Kidneys 

Etiology. — Passive  congestion  of  the  kidneys  is  produced 
by  heart  and  hmg  diseases  and  by  pressure  upon  the  renal 
veins  as  in  pregnancy,  dropsy  and  abdominal  tumors.  Active 
congestion  of  the  kidneys  is  seen  in  the  first  stages  of 
nephritis,  or  after  the  taking  of  irritating  drugs.  Both  forms 
of  congestion,  no  matter  what  the  direct  causes  may  be,  are 
superinduced  by  faulty  innervation,  as  a  result  of  a  subluxa- 
tion producing  impingement  upon  those  nerves  which  supply 
the  kidneys. 

Pathology. — The  kidneys  are  enlarged,  and  in  passive  con- 
gestion they  are  of  a  blue  color,  while  in  active  congestion, 
their  color  is  red.  A  catarrhal  condition  of  the  tubules  is  pres- 
ent, together  with  proliferation  of  the  connective  tissue  of  the 
parenchyma  of  the  kidney,  causing  it  to  become  hardened  and 
contracted. 

Symptoms. — In  passive  congestion  the  alterations  of  the 
kidney  are  overshadowed  by  the  heart  and  lung  symptoms, 
but  later  it  becomes  evident  that  the  kidneys  are  affected  when 
ascites  is  present,  and  the  urine  becomes  very  much  diminished 
in  amount,  contains  albumin,  and  is  high  colored.  In  the 
active  form  of  congestion  of  the  kidneys,  there  is  pain  in  the 
lumbar  region,  which  extends  towards  the  front,  and  follows 
the  course  of  the  ureters  into  the  testes.  The  bladder  is  very 
irritable,  the  urine  scanty,  and  may  contain  blood,  casts,  fibrin 
and  albumin.  There  is  a  constant  desire  to  urinate,  but  usually 
no  pain  accompanies  the  act  of  urination.  Constitutional 
symptoms,  such  as  a  general  feeling  of  discomfort,  nausea  and 
vomiting,  and  headache  are  present. 

Treatment. — Adjust  the  10th  dorsal  vertebra,  and  any 
others  which  may  be  found  subluxated.  Concussion  of  the 
7th  cervical  vertebra.  As  soon  as  the  diagnosis  has  been  made, 
the  patient  should  be  put  in  bed,  a  liquid  diet  prescribed,  and 

519 


520  SPINAL  ADJUSTMENT 

the  bowels  cleansed  by  an  enema.  The  cause  should  then  be 
ascertained  and  treatment  directed  toward  its  removal.  Rectal 
dilatation  by  stimulating  the  circulation  is  very  useful  espe- 
cially in  the  passive  form  of  congestion,  in  which  there  is  too 
little  blood  in  the  arteries,  and  too  much  blood  in  the  veins. 
Concussion  of  the  7th  cervical  and  the  2nd  dorsal  vertebrae 
will  stimulate  the  heart  action,  and  thus-  also  assist  in  over- 
coming the  passive  congestion. 

Acute  Parenchymatous  Nephritis  (Acute  Bright's  Disease) 

Etiology. — The  most  common  causes  of  acute  Bright's 
disease  are  exposure  to  cold  and  wet,  infectious  diseases,  and 
the  use  of  irritant  drugs,  which  are  eliminated  by  the  kidneys. 
It  also  occurs  in  connection  with  some  skin  diseases,  and  acute 
infectious  fevers.  These  conditions  all  cause  more  or  less 
irritability  of  the  kidneys,  as  a  result  of  which  reflex  subluxa- 
tions are  produced  in  the  segments  which  control  the  kid- 
neys, namely  the  10th  thoracic,  and  as  a  result  of  these  spinal 
lesions,  the  conduction  of  impulses  to  the  kidneys  are  inter- 
fered with,  and  functional  and  organic  derangements  ensue. 
It  is,  however,  frequently  due  to  direct  injuries  of  the  back, 
which  induce  a  subluxation  about  the  10th  thoracic  vertebra, 
and  which  later  predispose  to  Bright's  disease. 

Pathology. — The  kidneys  are  increased  in  size,  congested, 
and  of  a  very  red  color.  Later  on  the  tubules  become  engorged 
with  epithelial  cells,  blood  corpuscles  and  fibrin.  The  capsule 
of  the  kidney  is  very  loose.  If  proper  treatment  is  instituted, 
and  the  case  terminates  favorably,  the  organ  returns  to  its 
normal  size,  the  congestion  disappears,  and  the  tubules  regain 
their  normal  state. 

Symptoms. — The  disease  usually  commences  suddenly, 
with  a  chill.  Dropsy,  dyspnea,  and  prostration  then  develop. 
There  is  usually  a  moderate  rise  in  temperature.  Gastro-in- 
testinal  symptoms  later  develop.  Pain  may  be  present  in  the 
lumbar  region,  although  this  is  not  a  constant  feature.  There 
is  an  almost  constant  desire  to  urinate.  The  pulse  is  tense, 
full  and  rapid,  and  the  skin  is  harsh  and  dry.  In  cases  which 
follow  scarlet  fever,  anemia  and  prostration  are  extreme. 
Symptoms  of  uremia  may  develop.  The  urine  is  scanty, 
smoky  and  of  a  high  specific  gravity.    Albumin,  together  with 


DISEASES  OF  GENITO-URINARY  SYSTEM  521 

hyaline,    g^ranular,    epithelial    and    blood    casts    are    present. 
Phosphates,  chlorides  and  urea  are  decreased  in  amount. 

Treatment. — Adjust  the  10th  to  12th  thoracic  vertebrae. 
The  patient  should  be  placed  in  bed,  and  remain  there  until  all 
symptoms  have  disappeared.  Hot  Epsom  salt  packs  should  be 
applied  over  the  region  of  the  kidneys.  The  diet  is  very  im- 
portant, and  during  the  height  of  the  disease  should  consist  of 
milk  only.  The  patient  should  drink  large  amounts  of  water. 
The  bowels  should  be  kept  open  by  the  use  of  enemas.  Free 
perspiration  should  be  induced  daily  by  the  use  of  a  hot  pack. 

Chronic  Parenchymatous  Nephritis  (Chronic  Bright's  Disease;  Large 

White  Kidney) 

Etiology. — The  primary  cause  of  this  disease  is  subluxa- 
tion of  the  10th  to  the  12th  thoracic  vertebrae,  which  inter- 
feres with  the  conduction  of  nerve  impulses  to  the  kidneys, 
and  induces  organic  changes  therein.  The  disease  may  follow 
the  acute  form,  in  which  case  it  is  the  result  of  reflex  subluxa- 
tions, which  occur  during  the  course  of  the  acute  variety. 
This  form  of  chronic  Bright's  disease  is  seen  most  commonly 
in  men  before  the  age  of  40.  Contributing  causes  are  constant 
exposure  to  wet  and  cold,  excessive  use  of  alcohol,  various 
forms  of  intoxication,  syphilis,  diseases  of  the  liver,  and  tuber- 
culosis. 

Pathology. — The  kidney  is  increased  to  twice  its  normal 
size,  and  of  a  white  or  yellowish  color.  The  tubules  are  thick- 
ened and  dilated,  and  engorged  with  epithelial  cells,  debris 
and  casts.  The  medullary  portion  of  the  kidney  is  thickened 
as  a  result  of  the  increase  in  the  amount  of  connective  tissue, 
and  as  the  disease  progresses,  this  connective  tissue  has  a 
tendency  to  become  contracted,  and  finally  the  kidney  becomes 
reduced  in  size,  and  its  surface  is  irregular. 

Symptoms. — The  disease  commences  very  gradually,  and 
its  onset  is  characterized  by  malaise,  anemia,  gastro-intestinal 
disorders,  edema  of  the  eye-lids,  especially  in  the  morning. 
difficult  breathing  and  palpitation  of  the  heart.  Later  symp- 
toms are  severe  headache,  dizziness,  failing  vision,  nausea  and 
vomiting,  and  general  dropsy.  Enlargement  of  the  heart  and 
high  blood  pressure  are  common  symptoms.  Symptoms  of 
uremia  may  develop  at  any  time  during  the  course  of  the 


522  SPINAL  ADJUSTMENT 

disease.  Irritability  of  the  bladder  is  an  early  and  constant 
symptom.  The  enormous  loss  of  albumin,  together  with  the 
gastro-intestinal  disturbances,  result  in  a  marked  amemia. 
The  urine  is  scanty,  highly  colored,  and  contains  albumin  and 
granular,  hyaline  and  fatty  casts.  Later  the  amount  of  urine 
may  become  increased.  All  the  normal  constituents  of  the 
urine  are  diminished  in  amount,  and  one  point  of  particular 
importance  is  the  fact  that  the  greater  the  diminution  of  the 
amount  of  chlorides  becomes,  the  greater  is  the  amount  of 
albumin  present,  and  the  more  unfavorable  the  prognosis  be- 
comes. Dangerous  complications  arise  during  the  course  of 
the  disease,  chief  among  which  are  uremia,  pneumonia,  en- 
largement of  the  heart,  apoplexy,  and  edema  of  the  lungs. 

Treatment. — Adjust  the  10th  to  12th  dorsal  vertebrae.  The 
next  most  important  measure  in  the  therapy  of  this  disease  is 
attention  to  the  diet,  since  an  unsuitable  diet  may  produce  a 
great  deal  of  harm.  The  diet  must  be  so  selected  as  to  keep 
up  the  body  weight,  or  even  to  increase  it.  At  the  same  time 
it  must  make  as  little  demands  upon  the  renal  activity  as  pos- 
sible, and  be  free  from  any  substance  which  could  possibly 
cause  an  irritation  of  the  kidneys.  The  patient  must  be 
guarded  against  taking  cold,  since  this  may  bring  on  an  acute 
attack.  He  should  keep  his  feet  well  protected,  and  wear 
woolen  underwear,  with  the  addition  of  a  flannel  band  about 
the  loins.  Residence  in  a  warm  climate  is  preferable.  Mod- 
erate exercise  in  the  open  air  is  advisable,  but  should  not  be 
excessive.  Overwork  and  mental  worry,  anxiety,  etc.,  should 
be  avoided.  The  bowels  should  be  kept  open  at  all  times. 
Hot  baths  followed  by  a  light  sweat  are  useful,  since  they 
keep  up  the  skin  secretions.  If  aterio-sclerosis  is  present,  care 
must  be  exercised  in  giving  the  baths.  To  harden  the  skin 
against  undue  sensitiveness  to  sudden  changes  in  temperature, 
Semola  suggests  a  dry  rub  down  each  day. 

Chronic  Interstitial  Nephritis  (Chronic  Bright's  Disease;  Small  Red 

Kidney) 

Etiology. — The  primary  cause  of  this  affection  is  the  fail- 
ure of  proper  innervation  of  the  kidney.  That  withdrawal  of 
innervation  may  produce  interstitial  nephritis  is  proven  by 
the  fact  that  changes  in  the  renal  ganglionic  centers  may  also 


DISEASES  OF  GENITO-URINARY  SYSTEM  523 

cause  this  disease.  It  is  seen  most  commonly  in  men  between 
the  ages  of  40  and  60  years.  It  may  also  occur  secondarily  to 
chronic  parenchymatous  nephritis.  Among  the  conditions 
which  predispose  to  the  contraction  of  this  disease  are  alco- 
holism, syphilis,  mental  worry,  grief  or  anxiety,  chronic  lead 
poisoning,  gout,  chronic  gonorrhea,  or  cystitis,  liver  diseases, 
and  passive  congestion,  as  a  result  of  heart  disease. 

Pathology. — There  is  first  of  all  an  inflammation  of  the 
intervening  connective  tissue  of  the  kidney,  which  is  of  a 
chronic  form,  and  results  in  hardening  and  contraction  of  the 
organ.  The  kidneys  are  very  much  diminished  in  size ;  their 
surface  is  granular,  and  covered  by  numerous  small  cysts,  and 
the  capsule  is  very  adherent.  The  cortex  of  the  kidney  is 
atrophied.  The  interstitial  tissue  of  the  kidney  is  converted 
into  fibrous  tissue.  The  arteries  are  very  much  sclerosed. 
The  glomeruli  are  degenerated  and  atrophied ;  the  tubules  are 
degenerated  and  converted  into  thread-like  capillaries. 

Symptoms. — The  disease  commences  so  insidiously  that 
often  it  is  not  recognized  until  serious  symptoms  appear.  For 
some  time  previously  the  heart  and  vessels  have  been  affected. 
The  characteristic  symptoms  of  the  disease  are  frequent  mic- 
turition of  large  amounts  of  a  pale,  highly  acid  urine,  of  low 
specific  gravity,  and  containing  a  very  small  amount  of  albu- 
min, which  may,  however,  not  be  evident  for  weeks  at  a  time 
Sometimes  epithelial  cells  and  granular  and  hyaline  casts  are 
present.  Progressive  anemia  is  a  common  symptom  of  the 
disorder,  and  there  is  great  weakness  and  loss  of  flesh  and 
strength.  Dyspnea  is  a  common  symptom.  There  is  no 
dropsy,  but  a  little  edema  of  the  eyelids.  Vision  is  impaired. 
Albuminuric  retinitis  is  present.  High  blood  pressure  is  a 
constant  feature,  and  heart  action  is  very  forcible,  owing  to 
the  hypertrophy  of  the  heart,  which  is  generally  present. 
Other  symptoms  are  headache,  dizziness  and  palpitation  of 
the  heart.  Uremia  may  develop  at  any  time  during  the  course 
of  the  disease,  and  is  shown  by  excessive  digestive  disturb- 
ances, headache,  dizziness,  drowsiness,  convulsions,  or  apo- 
plectic attacks. 

Treatment. — Adjust  the  10th  to  the  12th  dorsal  vertebrae. 
In  general  the  treatment  is  the  same  as  that  of  the  chronic 
parenchymatous  form  of  Bright's  Disease. 


524  SPINAL  ADJUSTMENT 

Uremia 

Etiology. — This  is  a  group  of  symptoms  rather  than  a 
specific  disease,  and  the  cause  is  the  absorption  by  the  blood 
of  excrementitious  matter  which  should  be  excreted  by  the 
urine.  The  resulting  intoxication  is  manifested  by  a  group  of 
extreme  nervous  phenomena.  It  is  seen  during  the  course  of 
acute  or  chronic  Bright's  disease. 

Symptoms. — Uremia  exists  in  two  forms,  the  acute  and 
chronic.  In  the  acute  form  of  uremia  the  onset  may  be  slow 
or  sudden.  The  common  symptoms  present  are  headache, 
which  is  usually  in  the  occipital  region,  and  extends  down  the 
back  of  the  neck,  nausea  and  vomiting,  dyspnea,  vertigo,  in- 
somnia, or  stupor,  and  convulsions.  The  convulsions  may  be- 
come more  and  more  severe,  and  the  patient  finally  passes 
into  a  comatose  condition.  The  common  symptoms  of  chronic 
uremia  are  similar  to  those  of  acute  uremia,  but  less  severe. 
There  is  constant  headache  and  dyspnea,  nausea  and  vomiting, 
insomnia,  cramps  in  the  calves,  and  itching  of  the  skin.  Con- 
vulsions or  twitchings  of  the  muscles  occur  at  times.  The 
urine  is  diminished  in  amount,  contains  large  amounts  of 
albumin,  and  a  diminished  amount  of  urea.  The  blood  con- 
tains a  large  amount  of  urea. 

Treatment. — The  chronic  form  of  uremia  is  treated  in  the 
same  manner  as  chronic  Bright's  disease.  In  acute  uremia 
adjust  the  1st  and  2nd  cervical,  and  the  6th  and  10th  dorsal 
vertebrae.  Free  perspiration  should  be  induced  by  the  use 
of  hot  magnesium  sulphate  baths.  Free  action  of  the  kidneys 
is  stimulated  by  the  application  of  hot  compresses  over  the 
region  of  the  kidneys,  and  enemas  of  normal  salt  solution. 

Amyloid  Kidney   (Waxy  Kidney) 

Etiology. — Waxy  degeneration  of  the  kidneys  is  seen  in 
chronic  suppuration,  lead  poisoning,  gout,  and  leukemia.  It 
often  follows  chronic  parenchymatous  nephritis.  It  is  seen 
in  connection  with  waxy  degeneration  of  the  spleen  and  liver. 

Pathology. — The  kidneys  are  enlarged  and  hard,  and  have 
a  peculiar  waxy  appearance,  which,  on  being  treated  with  a 
solution  of  iodine,  change  to  a  deep  mahogany  red  color. 
Lesions  showing  chronic  nephritis  are  also  present. 

Symptoms. — The  previous  personal  history  of  the  patient 


DISEASES  OF  GEN  ITO-URl NARY  SYSTEM  525 

must  be  taken  into  consideration,  and  it  must  be  determined 
whether  or  not  there  is  an  associated  enlargement  of  the  liver 
and  spleen.  Dropsy  and  diarrhea,  together  with  uremic  symp- 
toms, and  high  blood  pressure,  are  present  in  connection  with 
a  profound  cachexia.  The  urine  is  increased  in  amount,  of  a 
low  specific  gravity,  and  a  pale  color.  Albumin  is  present, 
together  with  hyaline,  s^ranular  and  fatty  casts. 

Treatment. — The  treatment  is  the  same  as  that  of  chronic 
interstitial  nephritis.  In  addition  to  this  the  underlying  cause 
must  in  all  cases  be  attended  to. 

Movable  Kidney  (Floating  Kidney) 

Etiology. — The  primary  cause  of  this  condition  is  an  inter- 
ference with  the  nerve  supply  of  the  supports  of  the  kidney, 
as  a  result  of  which  the  tissues  about  the  kidney  become  so 
lax  and  atrophic  that  the  kidney  is  permitted  to  leave  its 
normal  location,  and  float  about  in  the  abdomen.  This  con- 
dition is  seen  most  commonly  in  women,  and  important  con- 
tributing causes  are  relaxation  of  the  abdominal  wall,  wearing 
of  tight  corsets,  trauma,  increased  weight  of  the  kidneys, 
rapid  emaciation,  and  pressure  upon  the  kidney  by  tumors 
adjacent  to  it. 

Symptoms. — In  some  cases  the  patient  is  unaware  of  the 
condition,  and  should  then  not  be  told  of  it,  for  the  tendency 
to  neurasthenia  in  those  who  are  aware  of  their  condition  is 
very  great.  The  most  important  symptoms  are  a  heavy  pain 
in  the  abdomen,  increased  by  standing  or  walking.  Various 
reflex  disturbances  such  as  neuralgic  pains,  irritability  of  the 
bladder  and  palpitation  may  be  present.  At  times  the  ureters 
and  renal  vessels  may  become  twisted,  and  paroxysms  of 
agonizing  pain,  known  as  Dietl's  crises  occur. 

Treatment. — Adjust  the  6th  and  10th  dorsal  vertebrae,  and 
any  other  subluxations  which  may  be  found  after  a  careful 
spinal  analysis  has  been  made.  In  addition  to  this  the  gen- 
eral health  should  be  improved  by  the  use  of  suitable  diet, 
well  directed  exercises,  and  hygienic  measures.  Sometimes 
the  condition  is  relieved  by  lying  on  the  back  for  an  hour  or 
two  each  day,  while  in  other  cases  relief  is  obtained  by  wear- 
ing a  suitable  support  or  binder,  to  keep  the  kidney  in  its 
proper  position.    When  the  paroxysms  due  to  the  twisting  of 


526  SPINAL  ADJUSTMENT 

the  ureters  occur,  the  patient  should  be  placed  in  bed,  and  hot 
applications  over  the  lumbar  region  are  indicated.  Usually, 
however,  the  adjustments  alone  will  suffice  to  produce  a  cure, 
by  restoring  the  normal  tonicity  to  the  supports  of  the  kidney, 
through  restoration  of  their  nerve  supply. 

Hydronephrosis 

Etiology. — This  is  a  cystic  condition  of  the  kidney,  which 
is  due  to  an  obstruction  of  the  ureter,  by  twisting,  calculus,  or 
tumors.  As  a  result  of  the  obstruction  of  the  ureter,  the 
urinary  secretion  is  retained  in  the  kidneys. 

Pathology. — The  pelvis  of  the  kidney  is  first  dilated  by  the 
accumulating  fluid  and  as  its  amount  increases,  pressure  of 
the  fluid  upon  the  parenchyma  produces  gradual  atrophy  of 
the  kidney  structure,  until  the  whole  kidney  is  converted  into 
a  sac  containing  fluid. 

Symptoms. — As  soon  as  the  amount  of  fluid  becomes  large, 
a  soft,  fluctuating  tumor  appears  in  the  lumbar  region.  This 
tumor  is  the  cystic  kidney,  and  contains  a  serous  fluid,  con- 
taining uric  acid  and  urea.  The  tumor  is  painless  on  palpa- 
tion, and  dullness  is  elicited  upon  percussion  over  it. 

Treatment.— Adjust  the  6th  and  10th  dorsal  vertebrae, 
and  if  the  condition  is  acute,  it  may  be  further  relieved  by  the 
application  of  hot  compresses  of  magnesium  sulphate  solution. 
In  chronic  cases  the  treatment  is  usually  surgical. 

Nephrolithiasis  (Renal  Calculi,  Kidney  Stone,  Gravel) 

Etiology. — The  primary  cause  of  this  disease  is  a  disturb- 
ance of  the  innervation  to  the  kidneys  as  a  result  of  which  the 
urinary  secretion  is  changed,  and  the  salts  of  the  urine  are 
permitted  to  deposit,  and  form  either  gravel,  which  is  like  fine 
sand,  or  to  deposit  around  a  previously  existing  nucleus,  to 
form  a  stone.  The  nucleus  may  be  a  dried  particle  of  mucus 
or  blood,  or  consist  of  the  same  material  as  the  surrounding 
stone.  The  disease  occurs  most  commonly  in  men  between 
the  ages  of  40  and  50  years. 

Symptoms. — No  signs  of  this  condition  may  be  present 
until  a  stone  becomes  lodged  in  one  of  the  ureters,  when  an 
attack  of  renal  colic  takes  place.  This  is  shown  chiefly  by 
severe  pain  in  the  lumbar  region,  which  radiates  along  the 


DISEASES  OF  GEXITO-URIXARY  SYSTEM  527 

ureters  to  the  testicles.  Each  attack  of  colic  is  accompanied 
by  nausea  and  vomiting,  subnormal  temperature,  faintness, 
pallor  of  the  face,  and  irritability  of  the  bladder.  Upon  the 
stone  passing  into  the  bladder,  the  symptoms  disappear.  The 
amount  of  urine  is  diminished,  on  account  of  the  obstruction 
of  the  ureter,  and  the  urine  which  is  voided,  contains  small 
amounts  of  blood.  Should  the  condition  be  present  on  both 
sides,  namely  both  ureters  obstructed,  uremia  will  develop. 
Between  the  attacks  of  renal  colic  there  is  always  a  certain 
amount  of  pain  and  soreness  over  the  kidneys,  and  the  urine 
is  stained  wath  blood.  In  addition  to  the  presence  of  blood 
the  urine  also  contains  albumin  and  hyaline  casts,  and  its 
specific  gravity  is  high. 

Treatment. — Adjust  the  10th  to  12th  thoracic  vertebrae. 
During  the  attack  of  renal  colic,  the  patient  should  be  placed 
in  a  hot  bath.  Hot  compresses  should  be  applied  to  the  lum- 
bar region,  and  large  amounts  of  hot  water  should  be  drunk. 
During  the  interval  between  attacks  the  patient  should  drink 
freely  of  alkaline  mineral  water.  Meat  should  be  very  spar- 
ingly used  or  not  at  all,  and  the  diet  should  consist  principally 
of  milk  and  vegetables.  If  the  stone  is  large  or  if  numerous 
stones  are  present,  and  impair  the  kidney  or  ureters  so  as  to 
threaten  life,  surgical  measures  are  indicated. 

Pyelitis  (Pyelo-Nephritis;  Suppurative  Nephritis) 

Etiology. — The  primary  cause  of  this  disease  is  a  lack  of 
resistance  of  the  kidney  structure  to  the  invasion  of  bacteria, 
caused  by  faulty  innervation  of  the  organ.  A  catarrhal  con- 
dition of  the  pelvis  of  the  kidney  usually  precedes  the  in- 
vasion of  pus.  Predisposing  causes  are  exposure  to  cold  and 
wet,  inflammation  of  the  bladder,  long  use  of  irritating  drugs, 
rheumatism,  infectious  diseases,  and  kidney  stones. 

Pathology. — There  is  a  catarrhal  or  suppurative  inflamma- 
tion of  the  pelvis  of  the  kidney  and  ureters.  Pus  is  formed 
constantly,  and  escapes  with  the  urine,  when  there  is  no  ob- 
struction of  the  ureters ;  if,  however,  this  outflow  is  prevented, 
it  accumulates  in  the  kidneys,  and  gives  rise  to  the  disease 
known  as  Pyelonephrosis.  Pressure  of  the  accumulated  pus 
causes  an  atrophy  of  the  kidney  structure.  This  is  followed 
by  the  formation   of  pus  which   is  constantly  accumulating. 


528  SPINAL  ADJUSTMENT 

and  if  no  obstruction  of  the  ureter  is  present,  it  escapes  with 
the  urine.  If,  however,  its  outflow  is  impeded,  it  accumulates 
in  the  pelvis  of  the  kidney,  and  the  pressure  which  it  produces 
upon  the  parenchyma  of  the  kidney  causes  the  latter  to 
atrophy,  and  the  kidney  finally  becomes  converted  into  a  sac 
filled  with  pus,  in  other  words,  an  abscess.  The  kidney  is  now 
in  the  same  condition  as  in  hydronephrosis,  except  that  the 
fluid,  instead  of  being  water,  is  pus. 

Symptoms. — The  characteristic  symptoms  of  this  condi- 
tion are  pain  and  tenderness  on  deep  pressure  over  the  kid- 
neys. The  symptoms  common  to  septic  infection  in  any  part 
of  the  body,  namely  alternate  fever  and  chills,  occur.  The 
urine  is  cloudy  and  of  an  acid  reaction,  and  contains  mucous, 
pus  and  red  blood  corpuscles.  If  the  affection  becomes 
chronic,  anemia,  progressive  loss  of  flesh  and  strength,  and 
finally  cachexia  develop. 

Treatment. — In  mild  cases  adjustment  of  the  10th  to  12th 
thoracic  vertebrae  may  be  sufficient  to  overcome  the  condi- 
tion. In  addition  to  this  the  patient  should  remain  in  bed, 
and  drink  large  amounts  of  alkaline  mineral  water,  and  the 
diet  should  be  light  and  nutritious,  and  non-irritating.  Hot 
compresses  over  the  kidneys  are  very  beneficial.  In  chronic 
cases,  when  an  abscess  has  developed,  surgical  measures  are 
necessary. 

Cystitis  (Catarrh  of  the  Bladder) 

Etiology. — Catarrh  of  the  bladder  is  seen  in  two  forms, 
the  acute  and  the  chronic.  In  both  cases  the  primary  cause 
of  the  aiifection  is  an  interference  with  the  innervation  of  the 
organ.  This  lack  of  innervation  renders  the  bladder  susceptible 
to  the  invasion  of  the  contributing  causes,  chief  of  which  are 
the  infectious  fevers,  presence  of  foreign  bodies  in  the  blad- 
der, the  extension  of  a  suppurative  inflammation  to  the  blad- 
der from  the  kidneys  or  from  the  urethra,  traumatism,  and 
the  retention  of  urine  in  the  bladder  for  long  periods  of  time. 
The  chronic  form  may  be  engrafted  upon  the  acute  variety, 
or  the  integrity  of  its  mucous  lining  may  be  impaired,  by 
withdrawal  of  its  innervation,  when  the  addition  of  such 
causes  as  calculi,  retention  of  urine,  large  prostate  gland  or 
urethral  stricture,  gout,  and  chronic  Bright's  disease  are  present. 


DISEASES  OF  GENITO-URINARY  SYSTEM  529 

Pathology. — Acute  cystitis  commences  with  congestion  of 
the  mucous  membrane  during  the  course  of  which  small  blood 
vessels  may  rupture  and  cause  minute  hemorrhages.  If  the 
inflammation  is  extreme,  it  may  end  in  ulceration. 

In  chronic  cystitis  the  bladder  wall  is  thickened,  its  mucous 
lining  is  gray  and  covered  with  large  amounts  of  muco- 
purulent material. 

Symptoms. — Acute  cystitis  commences  very  suddenly  with 
a  chill,  slight  fever,  a  feeling  of  malaise,  insomnia  and  loss  of 
appetite.  There  is  frequent  urination,  which  is  accompanied 
by  intense  pain.  Pain  over  the  bladder,  in  the  inguinal  region, 
and  along  the  course  of  the  urethra,  is  present.  The  urine 
is  cloudy,  of  an  alkaline  reaction,  and  contains  red  blood  cells, 
pus,  and  epithelium. 

Chronic  cystitis  commences  slowly,  and  is  characterized 
by  a  dull  pain  over  the  bladder  and  frequent  voiding  of  small 
amounts  of  urine.  The  urine  is  alkaline  in  reaction,  and  con- 
tains large  quantities  of  pus.  If  an  ulcerative  process  is  pres- 
ent, intense  pain  over  the  bladder,  presence  of  blood  in  the 
urine,  and  loss  of  flesh  and  strength  will  be  noted.  In  all 
cases  the  symptoms  of  the  contributing  cause  are  present. 

Treatment. — Adjust  the  11th  dorsal  and  the  1st  and  5th 
lumbar  vertebrae.  Adjust  also  for  the  relief  of  the  causative 
factors.  Concussion  over  the  9th  dorsal  and  the  5th  lumbar 
vertebrae  is  indicated.  Rectal  dilatation  is  a  valuable  measure 
in  these  cases.  In  addition  to  this  treatment,  the  patient 
should,  in  all  acute  cases,  be  confined  in  bed,  and  placed  on  a 
milk  diet.  Hot  magnesium  sulphate  compresses  should  be 
applied  over  the  bladder.  Large  amounts  of  alkaline  mineral 
water  should  be  drunk  to  dilute  the  urine  as  much  as  possible. 
The  bowels  should  be  daily  cleansed  with  a  high  rectal  enema 
of  normal  salt  solution.  All  highly  seasoned  and  irritating 
foods  should  be  avoided. 

Hypertrophy  of  the  Prostrate 

Etiology. — The  primary  cause  of  enlargement  of  the 
prostate  gland  is  interference  with  the  conduction  of  normal 
nerve  impulses  to  the  organ.  It  is  seen  most  commonly  in 
men  about  the  age  of  60,  and  among  the  important  contributing 
causes  may  be  mentioned  sedentary  occupation,  cystitis,  slug- 


530  SPINAL  ADJUSTMENT 

gish  circulation,  a  foreign  body  in  the  bladder,  stricture  of  the 
urethra,  numerous  previous  attacks  of  gonorrhea,  excessive  use 
of  diuretic  drugs,  and  alcoholic  liquors,  exposure  to  cold,  gout, 
and  rheumatism,  traumatism,  and  habitual  straining  at  stool. 

Pathology. — The  prostate  gland  is  enlarged,  hard  and  in- 
durated. The  enlargement  is  uniform,  and  the  isthmus  and 
two  lateral  lobes  of  the  gland  can  be  distinctly  felt  as  three 
separate  tumors. 

Symptoms. — These  are  not  apparent  until  the  hypertrophy 
has  existed  for  some  time.  The  enlargement  is  not  painful  of 
itself,  and  pain  is  not  present  until  there  is  mechanical  inter- 
ference w^ith  the  function  of  urination.  Incontinence  of  urine 
at  night  is  a  common  symptom.  A  muco-purulent  urethral 
discharge  is  present.  The  patient  is  very  irritable ;  there  are 
alternating  chills  and  fevers,  digestive  disturbances,  loss  of 
flesh  and  strength. 

Treatment. — Adjust  the  12th  dorsal  and  the  3rd  and  5th 
lumbar  vertebrae.  Concussion  of  the  9th  to  12th  dorsal  ver- 
tebrae. Massage  of  the  gland  is  a  very  useful  adjunct  meas- 
ure. The  application  of  hot  compresses  over  the  seat  of  the 
prostate  glands  is  also  beneficial. 

Enuresis  (Bed-Wetting) 

Etiology. — The  primary  cause  of  this  condition  is  a  de- 
rangement of  the  functional  activity  of  the  bladder,  due  to 
faulty  innervation  or  an  irritable  condition  of  the  micturition 
centers.  It  may  also  be  produced  reflexly  from  some  irrita- 
tion of  the  genito-urinary  system,  and  is  seen  most  commonly 
in  persons  of  a  nervous  temperament,  who  are  suffering  from 
anemia  and  faulty  nutrition.  It  also  occurs  in  diseases  of  the 
central  nervous  system. 

Symptoms. — The  characteristic  symptom  is  unconscious 
voiding  of  urine.  This  occurs  especially  at  night,  and  may 
take  place  every  night,  or  only  at  intervals. 

Treatment. — Adjust  the  11th  dorsal  and  the  1st  and  5th 
lumbar  vertebrae.  Concussion  of  the  9th  dorsal  and  the  5th 
lumbar  vertebrae.  The  bowels  should  be  regulated.  The 
evening  meal  should  be  light  and  no  liquids  should  be  taken 
after  5  o'clock.  Look  for  lesions  in  the  genito-urinary  system, 
which  may  reflexly  induce  the  condition,  such  as  phimosis. 


CHAPTER  XII 

Diseases  of  the  Eye  and  Ear 

The  reader  will  note  that  not  all  diseases  of  the  eye  and 
ear  are  given.  This  is  so  for  the  reason  that  so  many  of  these 
diseases  are  obviously  in  the  realm  of  the  specialist  in  eye 
and  ear  diseases  and  only  those  which  we  know  respond  to 
treatment  by  spinal  adjustments  are  therefore  given. 

Lachrymation 

This  condition  is  a  symptom  rather  than  a  disease,  and  is 
characterized,  as  its  name  implies,  by  an  excessive  flow  of 
tears,  occasioned  by  irritation  of  the  eye  and  its  appendages, 
as  a  result  of  which  the  secretion  of  the  lachrymal  glands  is 
increased.  This  is  produced  by  an  overstimulation  of  the 
aflferent  nerves,  which  reflexly  excite  the  efferent  nerves  to 
over-activity,  with  the  resulting  increase  in  the  functional 
activity  of  the  lachrymal  gland.  The  treatment  consists  in 
adjustment  of  the  4th  cervical  and  upper  dorsal  vertebrae. 

Amblyopia 

By  this  term  is  meant  a  defect  in  vision  which  is  not  due 
to  a  lesion  of  the  eyeball  or  error  of  refraction.  When  the 
defective  vision  is  due  to  causes  other  than  those  mentioned, 
it  may  be  corrected  by  adjustment  of  the  4th  cervical  and  the 
1st,  3rd  and  5th  dorsal  vertebrae,  together  with  removal  of 
the  cause  which  may  be  present. 

Strabismus  (Squint) 

This  is  a  condition  in  which  the  lines  of  sight  do  not  meet 
at  the  objective  point.  The  vision  of  the  affected  eye  is  very 
often  defective.  Selected  cases  of  strabismus  or  squint,  may 
be  corrected  by  adjustment  of  the  4th  cervical,  and  the  1st, 
3rd  and  5th  dorsal  vertebrae.  When  the  condition  is  due  to* 
disuse,  as  is  true  in  some  cases,  the  better  eye  should  be  cov- 
ered, and  the  affected  eye  used  exclusively  for  a  time. 

531 


532  SPINAL  ADJUSTMENT 

Cataract 

A  cataract  is  an  opacity  of  the  lens  of  the  eye,  or  its  en- 
velope. In  some  cases  surgical  measures  are  the  only  means 
of  relief.  In  other  cases,  however,  adjustment  of  the  4th  cer- 
vical, and  the  1st,  3rd  and  5th  dorsal  vertebrae,  together  with 
concussion  of  the  1st,  4th  and  7th  cervical  vertebrae,  have  been 
productive  of  good  results  in  these  cases.  Important  adjunct 
measures  of  treatment  are  rectal  dilatation,  magnesium 
sulphate  baths,  and  compresses  over  the  affected  side,  and  the 
local  use  of  normal  salt  solution. 

Stye 

This  is  a  circumscribed,  acute  inflammation  of  the  tissues 
about  the  glands  of  the  margin  of  the  eyelid,  which  frequently 
terminates  in  suppuration.  Styes  very  often  occur  in  crops, 
and  are  seen  in  young  adults,  being  produced  most  commonly 
by  gastro-intestinal  disorders.  In  the  treatment  of  styes 
adjust  the  4th. cervical  and  the  1st,  3rd  and  5th  dorsal  verte- 
brae. If  the  case  is  seen  early,  cold  compresses  over  the  eye 
may  serve  to  abort  a  stye.  Attention  should  be  given  to 
the  gastro-intestinal  system. 

Ptosis 

This  is  a  drooping  of  the  upper  eye-lids,  due  to  paralysis, 
or  faulty  development  of  the  levator  palpebrae  muscle.  It 
may  exist  in  any  degree,  and  be  sufficient  to  entirely  cover 
the  eye.  It  may  be  congenital,  in  which  case  it  is  bilateral, 
and  is  due  to  faulty  development  of  the  levator  palpebrae 
muscle,  and  accompanies  congenital  defects.  The  acquired 
form  is  generally  unilateral,  and  is  caused  by  paralysis  of  a 
branch  of  the  3rd  nerve  that  innervates  the  levator  palpebrae. 
The  treatment  of  this  condition  should  consist  of  adjustment 
of  the  4th  cervical,  and  the  1st,  3rd  and  5th  dorsal  vertebrae. 
Electricity  may  also  be  used  to  directly  stimulate  the  muscle. 

Mydriasis  and  Myosis 

Mydriasis  is  the  term  used  to  designate  dilatation  of  the 
pupil,    while    myosis    designates   contraction    of   the   pupils. 
•  Mydriasis  may  be  due  to  paralysis  of  the  nerves  which  pro- 
duce contraction  of  the  pupil,  namely  the  third  cranial  nerve, 
or  to  stimulation  of  the  sympathetic  fibers,  which  normally 


DISEASES  OF  THE  EYE  AND  EAR  533 

dilate  the  pupil.  In  myosis  the  opposite  is  true,  namely,  there 
is  stimulation  of  the  3rd  cranial  nerve,  and  paralysis  of  the 
sympathetic  nerve  fibers.  This  condition  very  often  responds 
readily  to  adjustments  of  the  3rd  to  5th  cervical  vertebrae, 
and  the  1st,  3rd  and  5th  dorsal  vertebrae. 

Retinitis 

There  are  various  forms  of  inflammation  of  the  retina, 
namely  simple  retinitis,  albuminuric  retinitis,  syphilitic  re- 
tinitis, diabetic  retinitis,  and  hemorrhagic  retinitis.  Some 
cases  are  amenable  to  treatment,  while  others  are  not,  and  a 
guarded  prognosis  is  therefore  to  be  given  in  every  case. 
The  treatment  consists  in  adjustment  of  the  4th  cervical  and 
the  1st,  3rd  and  5th  thoracic  vertebrae.  The  eye  should  be 
protected  from  the  light,  and  should  not  be  used.  The  con- 
tributing causes  should  be  corrected. 

Optic  Neuritis 

Inflammation  of  the  optic  nerve  often  results  from  exten- 
sion of  an  inflammation  in  the  brain,  or  may  be  produced  by 
tumors  of  the  brain.  It  also  frequently  accompanies  anemia, 
arteriosclerosis,  rheumatism,  Bright's  disease,  syphilis,  and 
infectious  diseases.  Treatment  consists  in  adjustment  of  the 
4th  cervical  and  the  1st,  3rd  and  5th  dorsal  vertebrae.  Atten- 
tion should  also  be  given  to  the  cause  of  the  condition.  Hot 
baths  and  compresses  over  the  afifected  eye  are  useful 
measures. 

Ear-ache 

Ear-ache  is  a  symptom  of  nearly  all  abnormal  conditions 
of  the  auditory  apparatus,  and  w^hile  some  of  these  diseases 
are  not  always  amenable  to  spinal  adjustment,  the  pain  in 
the  ear  is  greatly  reduced  by  correction  of  subluxations  in 
the  upper  cervical  and  upper  thoracic  region.  Adjust  the  1st 
and  2nd  and  6th  cervicals,  and  the  1st,  3rd  and  5th  dorsal 
vertebrae.  A  valuable  accessory  method  of  treatment  is  the 
application  of  hot  compresses  over  the  ear. 

Tinnitus  Aurium 

A  ringing,  roaring  or  hissing  sound  in  the  ear  proceeds 
from  many  causes.     One  of  the  most  common  being  a  gen- 


534  SPINAL  ADJUSTMENT 

eral  neurasthenic  condition.  Congestion,  sunstroke,  alcohol- 
ism, and  arteriosclerosis,  are  also  responsible  for  this  disorder. 
Should  the  noises  be  synchronous  with  the  beat  of  the  heart 
and  of  a  pulsating  character,  and  further,  should  they  be  sus- 
pended by  pressing  on  the  carotid  arteries,  they  are  in  all 
probability  due  to  aneurysm,  inflammatory  congestion,  or 
paralysis  of  the  vaso-motor  nerves.  Continual  rushing,  pul- 
sating, knocking  noises  are  likely  caused  by  inflammatory 
conditions  in  the  labyrinth.  Bubbling,  gurgling,  singing  or 
shell-like  roaring,  indicates  fluid  exudations  or  catarrh  of  the 
Eustachian  tube.  A  dry,  roaring  and  ringing  sound  is  due  to 
catarrh  of  the  middle  ear,  or  insufificient  nerve-supply  to  the 
tympanum.  Many  such  cases  are  relieved  by  adjustment  of 
the  upper  cervical  vertebrae,  and  the  1st,  3rd  and  5th  dorsal 
vertebrae.     In  all   cases  the   cause   as   mentioned   should  be 

corrected. 

Deafness 

Deafness  may  be  due  either  to  a  disease  of  the  auditory 
apparatus,  or  to  a  lesion  affecting  the  integrity  of  the  auditory 
nerve.  To  distinguish  between  them,  a  vibrating  tuning  fork 
should  be  placed  upon  the  head,  and  if  the  vibrations  are 
heard,  it  is  an  indication  that  the  lesion  producing  the  deaf- 
ness is  located  in  the  auditory  apparatus ;  if  the  vibrations  are 
not  heard,  it  is  evidence  that  the  lesion  is  of  the  auditory 
nerve.  Deafness  is  produced  by  a  great  variety  of  causes, 
and  each  individual  case  should  be  carefully  studied,  with  a 
view  to  determining  the  exact  nature  and  location  of  the  con- 
tributing cause.  In  many  of  these  cases  adjustment  of  the 
upper  cervical  and  upper  dorsal  vertebrae,  supplemented  by 
treatment  directed  to  the  relief  of  the  causative  factors,  are 
productive  of  good  results. 

Otitis  Externa 

Inflammation  of  the  external  auditory  meatus  may  be 
either  acute  or  chronic,  and  afifect  the  greater  part  of,  if  not 
the  entire  lining  of  the  external  ear.  It  is  due  primarily  to 
faulty  innervation  of  the  parts,  as  a  result  of  which  its  resis- 
tance is  rendered  feeble,  and  it  becomes  susceptible  to  the  in- 
vasion of  various  forms  of  bacteria.  The  condition  com- 
mences  with   an   itching   sensation   in   the   external   auditory 


DISEASES  OF  THE  EYE  AND  EAR  535 

meatus ;  severe  radiating  pain  then  follows,  which  is  aggra- 
vated by  lying  upon  the  affected  side,  or  by  movements  of 
the  jaws.  Ringing  of  the  ears  and  deafness  may  occur.  Treat- 
ment of  this  affection  consists  in  adjustment  of  the  upper 
cervical  and  upper  dorsal  vertebrae.  Hot  compresses  over 
the  ear  are  useful  accessories  in  the  treatment. 

Otitis   Media 

Inflammation  of  the  middle  ear  may  occur  either  acutely 
or  chronically.  In  either  case,  but  more  especially  in  the 
chronic  form,  the  disorder  is  due  to  faulty  innervation  of  the 
middle  ear.  Contributing  causes  of  the  acute  variety  are  the* 
extension  of  an  inflammatory  process  from  the  nose,  sudden 
changes  in  temperature,  and  constitutional  debility.  The 
primary  cause  of  the  chronic  form  is  faulty  innervation  which 
is  due  to  reflex  subluxations  which  were  produced  during 
the  course  of  the  acute  form.  Contributing  causes  are  exces- 
sive use  of  alcohol  and  tobacco,  and  a  prolongation  of  the 
contributing  causes  of  the  acute  form.  The  condition  is  com- 
monly manifested  by  partial  deafness,  ringing  of  the  ears, 
and  pain.  These  symptoms  increase  in  severity,  and  fre- 
quently pus  forms  in  the  middle  ear,  and  systemic  disturb- 
ances then  become  marked.  The  treatment  of  many  of  these 
affections  should  be  left  to  the  specialist,  but  many  of  these 
cases,  if  taken  early,  are  relieved  by  adjustment  of  the  upper 
cervical  and  upper  dorsal  vertebrae.  Causative  factors  should, 
in  all  cases,  be  corrected. 

Vertigo 

Dizziness  may  be  due  to  a  great  variety  of  causes,  but 
is  essentially  produced  by  a  disturbance  of  the  cochlear  part 
of  the  auditory  nerve.  Auditory  Vertigo  is  due  to  disease  of 
the  labyrinth,  and  is  frequently  accompanied  by  nausea  and 
sometimes  syncope ;  this  form  of  vertigo  is  known  also  as 
Menier's  disease,  and  is  accompanied  by  deafness  and  tinni- 
tus. A  history  of  syphilis,  gout  or  injury  may  also  be  pres- 
ent. Vertigo  may  also  be  produced  reflexly  from  stomach 
disorders.  Anything  which  interferes  with  the  continuous 
flow  of  nerve-impulses  from  the  eye,  the  joints,  the  viscera, 
or  the  ear,  will  interfere  with  the  relation  of  the  body  to  ex- 
ternal objects,  and   will   produce  vertigo.     No  matter  what 


536  SPINAL  ADJUSTMENT 

the  varying  symptoms  may  be,  the  cause  is  in  all  cases  the 
same,  namely,  an  interference  with  the  nicely  balanced  co- 
relation  of  the  different  parts  of  the  body,  the  function  of 
which  is  to  maintain  the  consciousness  of  equilibrium.  When 
the  nerve  impulses  are  in  any  way  interfered  with,  the  result 
is  disharmony.  Such  a  disturbance  of  normal  vibrations  can 
also  be  produced  by  mechanical  causes,  as  the  movements  of 
cars,  ships,  or  whirling  rapidly  around.  In  such  cases  the 
symptoms  will  disappear  immediately  upon  removal  of  the 
promoting  cause,  since  in  such  cases  the  vibrations  are  at 
once  restored.  In  the  treatment  of  this  affection,  the  correc- 
tion of  the  cause  is  the  first  consideration.  In  all  cases 
adjustment  of  the  upper  cervical,  lower  dorsal  and  upper 
lumbar  vertebrae  should  be  made. 

Impacted  Cerumen 

By  this  term  is  meant  the  collection  in  the  external  audi- 
tory meatus,  of  an  increased  amount  of  ear-wax,  mixed  with 
debris,  and  rendered  dry  and  hard.  The  essential  symptoms 
are  similar  to  obstruction  of  the  auditory  meatus,  by  any 
foreign  body.  So  long  as  the  plug  of  wax  does  not  impinge 
against  the  drum  membrane,  no  symptoms  may  be  present. 
If  the  collection  of  wax  is  sufficient  to  occlude  the  meatus, 
tinnitus,  partial  deafness,  pain,  and  a  sense  of  fullness  in  the 
meatus,  are  the  leading  symptoms.  A  condition  of  malaise, 
reflex  cough,  and  nausea  and  vomiting  sometimes  occur. 
Treatment  consists  in  removal  of  the  collection  of  wax  by 
syringing  the  ear  with  a  warm  solution  of  sodium  bicarbon- 
ate. Adjust  the  upper  cervical  and  the  1st,  3rd  and  5th  dorsal 
vertebrae. 

Inflammation  of  the  Eustachian  Tube 

The  primary  cause  of  this  affection  is  a  low  grade  of  re- 
sistance of  the  Eustachian  tube,  induced  by  faulty  innervation. 
The  most  common  contributing  causes  are  extension  of  an 
inflammation  from  the  nose  or  throat ;  various  other  abnor- 
malities of  the  naso-pharynx ;  and  a  general  debilitated  condi- 
tion. Treatment  should  first  of  all  be  directed  toward  the 
removal  of  the  exciting  cause.  Following  this,  or  in  connec- 
tion therewith,  adjust  the  upper  cervical  and  the  noper  dorsal 
vertebrae. 


CHAPTER  XIII 

Gynecological  Diseases 

Some  gynecological  affections  are  so  manifestly  in  the 
realm  of  the  specialist  in  Diseases  of  Women,  that  they  will 
not  be  referred  to  here.  Only  such  as  are  amenable  to  spinal 
adjustment  and  local  therapy  will  be  discussed. 

Vulvitis 

Etiology. — Simple  vulvitis  is  contributed  to  by  lack  of 
cleanliness,  irritation,  and  the  presence  of  foreign  bodies,  all 
of  which  reflexly  excite  the  production  of  subluxations  in 
the  upper  lumbar  region,  as  a  result  of  which  the  inflammatory 
process  may  become  chronic. 

Symptoms. — The  affected  parts  are  red,  swollen,  con- 
gested, and  painful.  The  mucous  membrane  covering  the 
part  is  dry,  and  later  becomes  covered  with  a  mucous  secre- 
tion, and  desquamation  of  large  areas  of  the  mucous  membrane 
may  occur. 

Treatment. — The  prime  consideration  is  cleanliness,  and 
the  parts  should  be  washed  several  times  a  day  with  normal 
salt  solution.  Adjust  the  1st  to  3rd  lumbar  vertebrae.  If 
the  case  has  advanced,  the  use  of  astringents  locally,  may  be 
necessary. 

Pruritus   Vulvae 

Etiology. — This  condition  is  due  to  anything  which  pro- 
duces a  congestion  of  the  parts,  such  as  pregnancy  and  tu- 
mors. It  is  also  due  to  uncleanliness,  and  to  the  irritating 
effects  of  discharges  from  the  upper  part  of  the  genital  tract. 

Vaginitis 

Etiology. — The  predisposing  cause  of  inflammation  of  the 
vagina  is  a  general  impairment  of  the  health,  due  to  faulty 
innervation.  Other  predisposing  causes  are  any  conditions 
which  produce  congestion  of  the  pelvis,  as  tumors  and  preg- 
nancy.     The    exciting    causes    are    various    forms    of    local 

537 


538  SPINAL  ADJUSTMENT 

irritation,  such  as  discharges  from  the  uterus,  and  mechanical 
irritation. 

Symptoms. — Characteristic  symptoms  of  this  condition 
are  burning  pain  and  itching  about  the  opening  of  the  vagina, 
and  heavy  sensations  in  the  vagina  itself,  accompanied  by 
frequent  desire  to  micturate.  There  is  a  large  amount  of  a 
greenish  or  yellowish  discharge,  containing  a  small  amount 
of  blood,  and  consisting  of  mucus  or  muco-pus.  There  is 
also  a  dragging  pain  in  the  back  and  pelvis.  In  chronic  cases 
the  symptoms  are  very  similar,  though  not  so  marked.  In 
every  case  a  microscopical  examination  should  be  made  of 
the  discharge,  to  determine  the  presence  of  gonorrhea. 

Treatment. — Adjust  the  1st  and  3rd  lumbar  vertebrae. 
The  patient  should  refrain  from  moving  about  for  several 
days.  The  diet  should  be  liquid,  chiefly.  Douches  of  warm 
salt  solution  should  be  used. 

Dysmenorrhea 

Etiology. — There  are  several  forms  of  dysmenorrhea,  the 
most  common  of  which  are  membranous,  mechanical, 
congestive,  neuralgic,  and  ovarian. 

Membranous  Dysmenorrhea  is  painful  menstruation  due 
to  the  expulsion  of  membranes  and  clots  from  the  uterus. 
Mechanical  dysmenorrhea  is  painful  menstruation  due  to  ob- 
structions in  the  cervix,  the  os  uteri,  or  the  vagina.  Conges- 
tive dysmenorrhea  is  caused  by  any  condition  which  causes 
an  inflammation  of  the  pelvic  organs  or  cellular  tissue.  Neu- 
ralgic dysmenorrhea  is  seen  most  commonly  in  women  of  a 
nervous  temperament.  Ovarian  dysmenorrhea  is  due  to 
coincident  ovarian  disease. 

Symptoms. — In  membranous  dysmenorrhea  the  pain  com- 
mences a  short  time  before  the  onset  of  menstruation,  and  in- 
creases until  the  membrane  is  expelled.  These  pains  are 
cramp-like  in  character,  are  due  to  contractions  of  the  uterus, 
and  the  os  is  dilated.  A  profuse  flow  often  accompanies  this 
form  of  dysmenorrhea. 

In  mechanical  dysmenorrhea  the  pains  are  still  more 
cramp-like,  often  approaching  those  experienced  in  miscar- 
riage. The  obstruction  to  the  free  outflow  of  blood  causes  an 
accumulation  thereof  in  the  uterus  and  its  presence  induces 


GYNECOLOGICAL  DISEASES  539 

the  contractions  of  the  womb.  This  is  the  form  of  dysmenor- 
rhea which  is  seen  so  commonly  in  young  women  suffering 
from  anteflexion  of  the  uterus.  Following  one  pregnancy  this 
form  of  dysmenorrhea  usually  ceases,  since  the  ante-flexion 
is  corrected  by  the  tendency  to  retroversion,  which  always 
follows  pregnancy. 

Congestive  dysmenorrhea  is  accompanied  by  intense  pain 
in  the  pelvis  throughout  the  menstrual  period,  with  a  slight 
diminution  in  its  severity  when  relieved  by  a  temporarily 
free  flow.  Systemic  disturbances  are  present,  and  may 
sometimes  be  extreme. 

Neuralgic  dysmenorrhea  is  characterized  by  pain  which 
is  marked  just  before  and  for  the  first  few  hours  during  the 
menstrual  flow.  The  pain  is  situated  in  the  pelvis  and  extends 
around  to  the  lumbar  region.  It  is  a  steady,  sharp  pain,  and 
not  cramp-like,  as  that  in  the  other  forms  of  dysmenorrhea. 
There  are  no  signs  of  inflammation,  and  the  flow  is  steady, 
and  contains  no  clots. 

In  ovarian  dysmenorrhea  the  pain  is  always  present  be- 
fore the  onset  of  the  flow  although  it  may  commence  several 
days  before  it.  The  pain  is  experienced  in  the  pelvis,  and 
is  referred  down  the  thigh,  and  the  mammary  glands  may  be- 
come sensitive.  There  is  often  extreme  nervousness  and 
sometimes  hysteria. 

Treatment. — In  all  cases  adjust  the  1st  and  3rd  lumbar 
vertebrae.  In  congestive  dysmenorrhea,  concuss  the  spinous 
process  of  the  7th  cervical  vertebra.  In  membranous  and  me- 
chanical dysmenorrhea,  pressure  applied  upon  the  nerves  be- 
tween the  2nd  and  3rd  lumbar  vertebrae  often  serves  to 
stimulate  the  flow.  The  cause  should  be  ascertained  in  every 
case,  and  treated  accordingly.  Hot  compresses  should  be 
applied  over  the  lower  part  of  the  abdomen ;  hot  sitz-baths 
should  be  taken,  and  hot  vaginal  douches  should  be  given.  A 
rectal  enema  is  sometimes  beneficial.  IMeasures  should  be 
taken  to  improve  the  general  state  of  health. 

Menorrhagia  and  Metrorrhagia 

Etiology. — Menorrhagia  is  an  abnormally  profuse  men- 
strual discharge.  IVIetrorrhagia  is  a  flow  of  blood  from  the 
uterus  at  times  other  than  the  menstrual  period.    These  con- 


540  SPINAL  ADJUSTMENT 

ditions  are,  in  reality,  symptoms  rather  than  diseases,  per  se. 
The  most  common  causes  not  in  direct  relation  with  the 
uterus  itself,  are  hemophilia,  extra-uterine  pregnancy,  dis- 
eases of  the  ovaries  and  tubes,  and  diseases  of  the  heart,  liver 
and  kidneys.  Uterine  disorders  which  may  cause  these  symp- 
toms are  subinvolution,  malignant  disease,  endometritis,  and 
perimetritis,  incomplete  abortion,  and  polypi. 

Treatment. — Adjust  the  1st  and  3rd  lumbar  vertebrae. 
Concussion  of  the  1st,  2nd  and  3rd  lumbar  vertebrae.  In  all 
cases  the  cause  should  be  ascertained,  and  proper  treatment 
instituted.  Vaginal  douches  of  water,  as  hot  as  can  be  borne, 
are  beneficial.     Sometimes  it  becomes  necessary  to  pack  the 

vagina. 

Amenorrhea 

Etiology. — Absence  of  the  menstrual  flow  may  be  normally 
caused  by  pregnancy;  it  is  also  normally  present  in  lactation 
and  during  the  menopause.  Abnormal  amenorrhea  is  caused 
chiefly  by  exposure  to  cold  and  wet,  mental  or  physical  shocks, 
sorrow,  etc.,  accompanying  various  diseases,  stenosis  of  the 
cervix,  obesity,  infantile  uterus,  a  vicarious  flow,  and  anything 
which  makes  great  demands  upon  the  nervous  system. 

Symptoms. — The  symptoms  present  are  usually  referable 
to  the  primary  cause  of  the  condition. 

Treatment. — Adjust   the    1st   and    3rd    lumbar   vertebrae. 

Pressure   upon  the  nerves  betwen  the  2nd  and  3rd   lumbar 

vertebrae.     Hot  compresses  over  the  abdomen;  hot  vaginal 

douches ;  and  warm  sitz  baths.    In  all  cases,  treatment  should 

be  directed   toward   the   relief   of  the   primary   cause  of  the 

condition. 

Leucorrhea 

Etiology. — A  whitish  mucous,  or  muco-purulent  discharge 
is  seen  in  prolapse  of  the  uterus,  retrodisplacement,  carcinoma 
of  the  uterus,  and  anteflexion. 

Treatment. — Leucorrhea  being  a  symptom  rather  than  a 
disease,  per  se,  the  primary  cause  thereof  should  be  corrected. 
In  all  cases  adjust  the  1st  and  3rd  lumbar  vertebrae.  Hot 
douches  of  normal  salt  solution  are  beneficial. 

Anteflexion 
Etiology. — A  bending  forward  of  the  body  of  the  uterus 
upon  the  cervix  is  seen  most  commonly  in  those  who  have 


GYNECOLOGICAL  DISEASES  541 

not  borne  children.  The  tendency  of  pregnancy  is  to  result 
in  retroversion,  which  tendency  invariably  corrects  a  previous 
anteflexion.  The  uterus  being  normally  in  a  slightly  ante- 
flexed  condition,  accentuation  of  this  position  is  more  readily 
brought  about  than  is  retroversion.  Among  the  causes  which 
directly  operate  to  produce  the  forward  position  of  the 
uterus  may  be  mentioned  inflammation  and  consequent  short- 
ening of  the  sacro-uterine  ligaments,  which  draw  the  cervix 
upward  and  backward,  and  thus  throw  the  fundus  forward ; 
anything  which  causes  an  increase  in  the  weight  of  the  uterus, 
will,  according  to  its  location,  induce  malposition  of  the  womb, 
and  thus  this  condition  may  also  induce  anteflexion ;  adhesions 
between  the  uterus  and  the  abdominal  wall,  as  a  result  of 
perimetritis  or  peritonitis,  may  also  draw  the  body  of  the 
uterus  forward,  and  flex  it  upon  the  cervix. 

Symptoms. — The  characteristic  symptoms  of  this  condi- 
tion are  sterility,  dysmenorrhea,  menorrhagia,  leucorrhea, 
and  symptoms  referable  to  the  exciting  cause  of  the  condition. 

Treatment. — Adjust  the  1st  and  3rd  lumbar  vertebrae. 
Concussion  of  the  1st,  2nd,  and  3rd  lumbar  vertebrae.  When 
adhesions  are  present,  binding  the  uterus  in  its  abnormal 
position,  manipulations  are  necessary  to  replace  it  in  its  prop- 
er position.  This  is  accomplished  by  raising  the  fundus  with 
two  or  three  fingers  placed  in  the  vagina,  and  at  the  same 
time  drawing  the  cervix  forward.  This  method  either  finally 
breaks  the  adhesions,  or  stretches  them ;  the  use  of  tampons 
placed  behind  the  cervix  will  serve  to  hold  it  in  place.  If 
the  anteflexion  is  due  to  inflammation  of  the  uterus,  hot  saline 
douches  should  be  given  twice  daily.  In  all  cases  the  bowels 
should  be  carefully  regulated.  In  every  case  the  cause  should 
be  ascertained,  and  treatment  directed  toward  its  removal. 
It  goes  without  saying  that  surgical  measures  are  sometimes 

indicated. 

Anteversion 

Etiology. — In  this  condition  the  uterus  is  directed  for- 
ward, and  the  normal  bend  is  obliterated.  As  a  result  of  this 
the  cervix  is  higher  than  normal,  and  is  directed  backward 
toward  the  posterior  wall  of  the  vagina,  or  toward  the  hollow 
of  the  sacrum.  Probably  the  most  common  predisposing  cause 
of  this  condition  is  a  relaxation  of  the  uterine  ligaments,  ac- 


542  SPINAL  ADJUSTMENT 

companied  by  general  muscular  relaxation  throughout  the 
body.  The  most  common  contributing  or  exciting  causes 
are  subinvolution  of  the  uterus  following  abortion ;  any  in- 
crease in  the  weight  of  the  uterus,  as  congestion,  hyper- 
trophy, or  tumors ;  weakness  of  the  other  supports  of  the 
uterus,  as  laceration  of  the  perineum  and  prolapse  of  the 
vagina ;  ill-fitting  corsets. 

Symptoms. — The  characteristic  symptoms  of  this  condi- 
tion are  sterility,  dysmenorrhea,  cystitis,  frequent  urination, 
rectal  tenesmus,  and  the  symptoms  of  the  exciting  cause  of 
the  condition. 

Treatment. — The  treatment  of  anteversion  is  the  same  as 
that  of  anteflexion. 

Retroflexion 

Etiology. — The  primary  and  predisposing  cause  of  this  con- 
dition is  a  weakness  of  the  uterine  ligaments  due  to  an 
interference  with  their  normal  nerve-impulses,  which  maintain 
them  in  a  state  of  constant  contraction.  The  most  common 
contributing  and  exciting  causes  are  anything  which  increases 
the  weight  of  the  uterus,  as  pregnancy,  hypertrophy,  tumors, 
and  subinvolution ;  adhesions  between  the  uterus  and  sacrum, 
or  those  resulting  from  pelvic  peritonitis;  mechanical  meas- 
ures, such  as  falls,  blows,  pressure  of  tumors  from  the  anterior 
aspect,  and  a  long  period  of  time  spent  in  the  dorsal  position, 
following  confinement ;  laceration  of  the  perineum. 

Symptoms. — There  is  a  continuous,  dull,  heavy  pain  in 
the  lower  part  of  the  back,  and  radiating  down  the  thighs. 
Headache  is  a  constant  symptom  of  this  condition,  the  pain 
being  situated  most  commonly  at  the  vertex  or  in  the  occipi- 
tal region.  Symptoms  referable  to  the  uterus  itself  are  steril- 
ity, or  repeated  abortions,  dysmenorrhea,  menorrhagia  and 
leucorrhea.  Constipation  is  an  almost  constant  symptom, 
ribbon-like  stools  being  a  characteristic  of  this  condition,  and 
tenesmus  occurring  after  defecation.  Cystitis  may  be  present 
and  partial  incontinence  of  urine  is  a  common  symptom. 
After  a  time  many  nervous  symptoms  develop,  such  as 
hysteria,  melancholia,  neurasthenia  and  other  functional 
neuroses. 

Treatment. — Adjust    the    1st    and    3rd    lumbar    vertebrae. 


GYNECOLOGICAL  DISEASES  543 

Concussion  of  the  1st,  2nd  and  3rd  lumbar  vertebrae.  An 
accessory  measure  which  often  meets  with  success  is  the 
assuming  by  the  patient  of  the  knee-chest  position  for  30 
minutes  every  morning  and  evening.  When  adhesions  are 
present,  replacement  of  the  uterus  in  its  normal  position  may 
be  necessary  by  means  of  manipulation.  Following  the 
manipulations,  the  introduction  of  a  tampon  to  maintain  the 
uterus  in  its  normal  position,  is  advisable. 

Prolapse  of  the  Uterus 

Etiology. — This  is  a  downward  displacement  of  the  uterus, 
which  is  primarily  due  to  the  relaxation  of  its  ligaments  con- 
sequent on  improper  innervation  thereof,  in  addition  to  which 
chronic  constipation,  general  weakness,  overwork  and  a  large 
number  of  poorly-conducted  labors  are  also  common  pre- 
disposing causes.  The  most  common  exciting  or  direct  causes 
are  anything  which  increases  the  weight  of  the  uterus,  such 
as  pregnancy,  hypertrophy  and  tumors ;  loss  of  the  supports 
of  the  uterus,  such  as  laceration  of  the  perineum,  weakness 
of  the  abdominal  muscles,  an  extremely  large  pelvis,  and  poor 
tonicity  of  the  vaginal  vvalls ;  downward  displacement  of  the 
uterus  by  pressure  from  above,  as  tight-lacing,  tumors  in 
the  abdomen,  dropsy,  coughing,  or  straining  at  stool ;  condi- 
tions which  produce  a  pulling  downward  of  the  uterus  from 
below,  as  prolapse  of  the  bladder,  rectum  or  vagina. 

Symptoms. — The  characteristic  symptoms  of  this  condi- 
tion are  a  dragging,  bearing-down  weight  in  the  pelvis,  pain 
in  the  lower  part  of  the  back  and  radiating  down  the  thighs, 
vertical  or  occipital  headaches,  constipation,  irritability  of  the 
bladder,  tenesmus,  and  various  nervous  symptoms,  such  as 
hysteria,  and  neurasthenia.  Various  degrees  of  prolapse  of 
the  uterus  may  occur ;  first,  the  cervix  may  rest  on  the  pelvic 
floor ;  second,  it  may  protrude  at  the  vaginal  orifice ;  third,  the 
entire  uterus  may  escape  through  the  vaginal  orifice.  Accom- 
panying this  condition  there  may  be  a  protrusion  or  prolapse 
of  the  posterior  wall  of  the  vagina,  namely  rectocele,  or  of  the 
anterior  wall  of  the  vagina,  namely  cystocele. 

Treatment. — The  first  indication  is  to  replace  the  uterus, 
which  should  be  done  by  having  the  patient  assume  the  knee- 
chest  position.     In  cases  which  have  not  existed  for  too  long 


544  SPINAL  ADJUSTMENT 

a  period,  several  weeks'  rest  in  bed,  with  the  vagina  packed 
with  cotton  daily,  together  with  adjustment  of  the  1st  and 
3rd  lumbar  vertebrae,  and  concussion  of  the  1st,  2nd  and  3rd 
lumbar  vertebrae,  may  produce  excellent  results.  In  advanced 
cases,  however,  surgical  measures  are  sometimes  necessary. 

Acute    Endometritis 

Etiology. — Inflammation  of  the  mucous  lining  of  the 
uterus  may  afifect  the  entire  organ  or  any  part  of  it,  and  is 
primarily  due  to  an  interference  with  the  proper  innervation 
of  the  organ.  The  most  contributing  causes  are  exposure 
to  cold  and  wet  just  before  or  during  menstruation,  dysmenor- 
rhea, septic  infection,  and  extension  upward  of  an  inflamma- 
tion in  the  vagina,  and  chronic  exhausting  diseases,  espe- 
cially tuberculosis  and  Bright's  disease,  and  accompanying 
long,  continued  fevers. 

Symptoms. — The  first  symptom  of  this  disease  is  a  heavy 
sensation  and  pain  in  the  pelvis  together  with  pain  in  the 
back,  loins,  and  thighs.  There  is  mild  fever.  The  bladder 
and  rectum  are  both  irritable  and  frequent  micturition  and 
diarrhea  are  present.  The  discharge  appears  early  in  the 
condition  and  is  at  first  thin  and  watery,  which  indicates  that 
the  entire  uterus  is  afTected,  but  later,  as  the  inflammation 
subsides  in  the  fundus,  and  becomes  limited  more  particularly 
to  the  cervix,  the  discharge  becomes  thick  and  albuminous. 
In  many  cases  various  disorders  of  menstruation  develop.  If 
the  cause  is  a  gonococcus  infection,  all  the  above  symptoms 
are  intensified,  and  the  discharge  is  of  a  yellowish-green  color. 

Treatment. — The  first  indication  is  absolute  rest  in  bed. 
Adjustment  of  the  1st  and  3rd  lumbar  vertebrae,  and  concus- 
sion over  the  1st,  2nd  and  3rd  lumbar  vertebrae.  Hot  com- 
presses should  be  applied  over  the  hypogastric  region.  A 
liquid  diet  should  be  prescribed.  Hot  saline  douches  should 
be  given  twice  a  day.  Gonorrheal  and  septic  endometritis 
require  medicinal  treatment. 

Chronic  Endometritis 

Etiology. — Various  forms  of  this  condition  are  found,  the 
primary  cause  of  which  is,  in  all  cases,  faulty  innervation  of 
the  mucous  lining  of  the  uterus,  as  a  result  of  which  its  ton- 


GYNECOLOGICAL  DISEASES  545 

icity  is  impaired.  In  such  cases  it  is  simply  a  continuation 
of  the  acute  form,  or  results  from  an  untreated  chronic  vagin- 
itis. Other  direct  causes  of  chronic  endometritis  are  improp- 
erly conducted  labors,  miscarriage,  subinvolution,  insufficient 
rest  following  confinement,  exposure  to  cold  and  wet  at  the 
time  of  menstruation,  a  large  number  of  pregnancies,  anemia, 
insufficient  rest  after  confinement,  and  subinvolution  of  the 
uterus. 

Symptoms. — There  is  a  heavy,  dull  pain  in  the  lumbar 
region,  and  extending  down  the  thighs.  This  pain  is  increased 
by  the  upright  position,  in  which  case  pains  may  be  experi- 
enced also  in  various  other  parts  of  the  body.  A  frequent 
accompaniment  is  hemorrhage,  either  at  the  time  of  men- 
struation, or  between  the  menstrual  periods.  When  the  con- 
dition is  due  to  anemia,  amenorrhea  may  result.  Vertigo  and 
frontal  headache  are  common  symptoms.  A  leucorrheal  dis- 
charge is  a  constant  feature  of  this  condition,  and  when  due 
to  disease  of  the  cervix,  the  discharge  is  thick  and  gelatinous, 
while  when  it  is  from  the  body  of  the  uterus  it  is  thin  and 
watery.  If  the  condition  is  due  to  sepsis  or  to  gonorrhea  the 
discharge  is  yellowish  or  greenish.  Gastro-intestinal  and 
nervous   disorders   are  common   in  this   condition. 

Treatment. — The  first  consideration  in  the  treatment 
should  be  measures  directed  toward  the  improvement  of  the 
general  health,  and  prolonged  rest.  Adjust  the  1st  and  3rd 
lumbar  vertebrae.  Concussion  of  the  1st,  2nd  and  3rd  lumbar 
vertebrae.  Hot  douches  of  normal  salt  solution  should  be 
given  two  or  three  times  a  day. 

Acute  Metritis 

Etiology. — Inflammation  of  the  muscular  coat  of  the  uterus 
is  primarily  due  to  a  low  grade  of  resistance,  which  renders 
it  susceptible  to  the  invasion  of  the  contributing  causes  which 
are  in  most  instances  of  an  infectious  nature.  Such  causes 
may  be  gonorrheal.  The  infection  may  also  be  due  to  re- 
tained clots,  or  pieces  of  the  placenta,  or  to  the  use  of  un- 
clean hands  or  instruments.  It  also  follows  exposure  to  cold 
and  wet  during  the  menstrual  period.  It  is  sometimes  an  ac- 
companiment of  acute  infectious  diseases,  and  is  also  seen  in 
tuberculosis  and  Bright's  disease.     Aletritis,  never  occurs  in- 


546  ~      SPINAL  ADJUSTMENT 

depeiidently,  but  generally  is  the  result  of  extension  from  an 
inflammation  of  the  endometrium,  or  the  peritoneum. 

Symptoms. — The  disease  usually  commences  suddenly, 
with  a  chill.  This  is  followed  by  a  rapid  rise  in  temperature, 
and  an  increase  in  the  pulse  rate.  There  are  nausea  and 
vomiting,  and  frequent  urination  and  diarrhea.  Pain  is  a 
constant  feature,  and  is  experienced  in  the  hypogastric 
region  over  the  uterus,  and  also  in  the  lumbar  region  and 
iliac  region.  The  uterus  is  soft  and  enlarged.  Hemorrhages 
frequently  occur. 

Treatment. — Absolute  rest  in  bed,  and  if  the  case  is  seen 
early,  cold  compresses  over  the  uterus,  while  if  seen  later, 
hot  applications  are  the  first  considerations  in  the  treatment. 
Adjustments  of  the  1st  and  3rd  lumbar  vertebrae,  and  con- 
cussion of  the  1st,  2nd  and  3rd  lumbar  vertebrae.  An  enema 
should  be  given  every  day.  After  the  initial  stage  has  been 
passed  over,  hot  douches  of  normal  salt  solution  should  be 
given  several  times  a  day.  If  the  condition  is  due  to  reten- 
tion of  particles  of  placenta  or  clots,  removal  thereof  by 
surgical  means  may  be  necessary. 

Chronic   Metritis 

Etiology. — The  cause  of  chronic  metritis  is  a  prolonga- 
tion of  the  causes  of  the  acute  form,  when  left  untreated. 

Symptoms. — The  characteristic  symptoms  of  chronic 
metritis  are  a  constant  heavy  pain  in  the  hypogastric,  lumbar 
and  sacral  regions,  and  extending  down  the  thighs.  Vertigo 
and  occipital  headache  are  constant  symptoms  of  this  condi- 
tion. Painful  and  profuse  menstruation  occur,  and  at  other 
than  the  menstrual  time  there  is  a  leucorrheal  discharge. 
Frequent  micturition  and  diarrhea,  owing  to  irritability  of 
the  bladder  and  rectum,  are  common  symptoms.  Various 
nervous  diseases,  such  as  hysteria  and  neurasthenia,  frequent- 
ly are  noticed.  There  is  either  complete  sterility,  or  if  preg- 
nancy occurs,  abortions  are  the  rule.  During  the  acute  stages 
of  the  affection  the  uterus  is  enlarged  and  tender,  but  later 
It  becomes  reduced  in  size  owing  to  replacement  of  muscular 
tissues  by  fibrous  connective  tissue.  Displacements  of  the 
uterus  are  commonly  seen. 

Treatment. — Adjust  the  1st  and  3rd  lumbar  vertebrae,  and 


GYNECOLOGICAL  DISEASES  547 

concuss  the  1st,  2nd  and  3rd  lumbar  vertebrae.  General  mas- 
sage and  attention  to  diet  are  important  measures  in  this 
condition.  The  bowels  should  be  kept  well  regulated  by 
means  of  enemas  and  abdominal  massage.  Daily  douches  of 
hot  saline  solution  are  valuable  measures.  The  general 
health  of  the  patient  should  be  improved  in  every  possible 
way.     Rest  in   bed   during  the  menstrual  period  is  a  good 

procedure. 

Salpingitis 

Etiology. — Inflammation  of  the  mucous  lining  of  the  Fal- 
lopian tubes  is  most  commonly  due  to  gonorrhea.  It  also  fol- 
lows septic  endometritis.  Frequently  it  occurs  following 
excessive  exercises,  or  exposure  to  cold  and  wet  during  the 
menstrual  period. 

Symptoms. — The  disease  occurs  in  two  forms,  acute  and 
chronic.  During  the  acute  period  of  the  disease  there  is  mild 
fever,  and  an  acute,  heavy  pain  on  the  affected  side,  which 
is  increased  by  standing  or  walking.  If  a  tube  contains 
pus  the  usual  symptoms  of  sepsis  are  present,  and  the  patient 
lies  on  the  back,  with  the  thighs  flexed  upon  the  abdomen. 
The  characteristic  symptoms  of  the  chronic  form  are  pain  in 
the  lower  part  of  the  abdomen  on  the  side  of  the  affected 
tube,  which  is  increased  by  exertion  of  any  kind.  Sterility 
is  a  common  symptom  of  this  condition.  Dysmenorrhea  and 
profuse  menstruation  and  repeated  attacks  of  inflammation 
of  the  pelvic  peritoneum  are  common  symptoms.  If  a  bi- 
manual examination  be  made,  the  enlarged  tube  can  be  felt, 
and  it  will  also  be  noted  that  the  uterus  is  generally 
posteriorly  displaced. 

Treatment. — In  simple  catarrhal  salpingitis  the  patient 
should  remain  in  bed  for  some  time.  Adjust  the  1st  and  3rd 
lumbar  vertebrae.  If  the  case  is  seen  early,  cold  compresses 
on  the  affected  side  may  serve  to  abort  the  inflammation. 
Later  hot  applications  are  more  useful,  together  with  hot 
saline  douches,  and  sitz  baths  every  day.  In  some  cases 
surgical  measures  are  necessary. 

Congestion  of   the   Ovaries 

Etiology. — The  primary  and  predisposing  cause  of  this 
condition  is  faulty  innervation  of  the  ovaries,  whereby  the 


548  SPINAL  ADJUSTMENT 

blood  supply  therein  is  increased.  Contributing  causes  are 
chiefly  overwork,  especially  in  young  girls  at  school,  together 
with  lack  of  sufficient  exercise  and  fresh  air. 

Symptoms. — The  most  characteristic  symptom  of  this  af- 
fection is  pain  in  the  pelvic  region  for  several  days  preceding 
the  menstrual  period.  This  pain  gradually  diminishes,  as 
menstruation  becomes  established,  and  finally  disappears  al- 
together. The  patient  is  weak  and  chlorosis  is  usually 
present. 

Treatment. — Adjust  the  3rd  lumbar  vertebra.  Concussion 
of  the  1st,  2nd  and  3rd  lumbar  vertebrae.  The  patient  should 
be  given  a  sponge  bath  every  morning,  followed  by  a  brisk 
rub.  Candies,  and  pastries,  and  highly  seasoned  foods  should 
be  forbidden,  and  a  liberal  diet  of  plain  food  prescribed.  Often 
it  is  necessary  to  remove  these  patients  from  school  work  for 
some  time,  and  enforce  rest  and  an  outdoor  life. 

Acute  Oophoritis 

Etiology. — Inflammation  of  the  ovaries  is  due  to  a  great 
variety  of  causes,  chief  among  which  are  extension  of  an 
inflammation  or  infection  from  the  uterus  or  tubes,  such  as 
endometritis,  salpingitis,  gonorrhea,  or  septic  infection ;  dis- 
turbances of  menstruation ;  also  occurs  in  the  acute  eruptive 
fevers,  tuberculosis,  and  various  intoxications. 

Symptoms. — The  characteristic  sign  of  this  infection  is  an 
acute,  sharp  pain  over  the  iliac  region  of  the  afifected  side, 
and  radiating  down  the  back  and  thighs.  Accompanying 
this  there  is  marked  tenderness  over  the  inflamed  ovaries. 
Alternating  chills  and  fever,  and  a  rapid  pulse  are  present. 

Treatment. — Adjust  the  3rd  lumbar  vertebra  and  concuss 
over  the  1st,  2nd  and  3rd  lumbar  vertebrae.  The  patient 
should  be  confined  in  bed,  and  an  ice-bag  should  be  applied 
on  the  affected  side,  if  the  condition  is  seen  early,  while  later 
on  hot  applications  are  more  beneficial.  The  bowels  should 
be  cleansed  by  an  enema,  and  a  liquid  diet  should  be 
prescribed. 

Chronic  Oophoritis 

Etiology. — The  cause  of  this  condition  is  faulty  innerva- 
tion  of    the    ovary,    due    to    the    continuance    of    the    spinal 


GYNECOLOGICAL  DISEASES  549 

lesions  which  were  reflexly  induced  during  the  course  of  the 
acute  form,  and  left  uncorrected.  Chronic  inflammation 
of  the  ovary  also  accompanies  amenorrhea  and  various 
unnatural  acts,  in  respect  to  the  sexual  organs. 

Symptoms. — The  characteristic  symptoms  of  this  affection 
are  a  continuous  dragging  pain  over  the  affected  ovary,  and 
radiating  back  to  the  lumbar  region,  along  the  spine,  and 
down  the  thighs.  Headache  is  a  constant  symptom  of  this 
affection.  Rectal  and  vesical  irritation  are  present,  and  pain 
is  experienced  on  urination  and  defecation.  If  both  ovaries 
are  diseased,  sterility  results.  Various  forms  of  neuroses 
develop,  especially  hysteria.  The  menstrual  flow  is  profuse, 
amounting  sometimes  to  an  actual  hemorrhage. 

Treatment. — Adjust  the  3rd  lumbar  vertebra,  and  concuss 
over  the  1st,  2nd  and  3rd  lumbar  vertebrae.  During  the 
menstrual  period  the  patient  should  remain  in  bed.  Hot  saline 
douches  should  be  given  twice  a  day ;  the  bowels  should  be 
regulated  by  means  of  enemas.  Vaginal  massage  should  be 
used  to  prevent  adhesion  of  the  ovaries  to  surrounding 
structures.     Electricity  is  useful  in  this  condition  also. 

Pelvic  Peritonitis 

Etiology. — Inflammation  of  the  pelvic  peritoneum  and  cel- 
lular tissue  is  commonly  a  result  of  an  inflammation  of  the 
uterus,  tubes  and  ovaries,  and  most  usually  a  septic  inflam- 
mation of  the  tubes.  Other  causes  are  gonorrhea,  and  direct 
septic  infection,  from  unclean  hands,  instruments,  etc. 

Symptoms. — Pelvic  peritonitis  may  be  either  acute  or 
chronic.  In  the  acute  form  the  onset  is  sudden,  with  a  chill 
and  pain  and  tenderness  over  the  hypogastric  region.  The 
patient  lies  in  the  dorsal  position,  with  the  thighs  flexed  on 
the  abdomen  to  relieve  as  much  as  possible  the  muscular  ten- 
sion, and  thus  the  pain.  The  abdomen  is  distended  and 
tympanitic;  there  is  constipation,  irritability  of  the  bladder, 
and  sometimes  nausea  and  vomiting. 

The  symptoms  of  the  chronic  form  of  pelvic  peritonitis 
are  a  dull,  aching,  dragging  pain  in  the  pelvic  region,  dis- 
orders of  menstruation,  leucorrhea,  and  irritability  of  the 
bladder  and  rectum. 

Treatment. — Adjust   the   lower   dorsal   and   upper  lumbar 


550  SPINAL  ADJUSTMENT 

vertebrae.  Concussion  should  also  be  used  over  the  same 
vertebrae.  In  acute  cases  rest  in  bed  is  essential,  and  if  the 
case  is  seen  early,  cold  applications  over  the  abdomen  are 
useful.  Later  on,  however,  hot  compresses  should  be  used. 
A  liquid  diet  should  be  prescribed,  and  the  bowels  cleansed 
by  an  enema  each  day.  The  chronic  form  is  treated  chiefly 
by  adjustments,  concussions  and  massage,  together  with 
attention  to  the  general  health  of  the  patient. 


/ 


CHAPTER  XIV 

Diseases  and  Injuries  of  the  Spine  and  Deformities 
Scoliosis 

Etiology. — The  principal  causes  of  lateral  curvature  of  the 
spinal  column  are  the  following:  Rickets  in  young  children 
may  frequently  cause  a  lateral  curvature  on  account  of  the 
softened  condition  of  the  bones.  Occasionally  the  condition 
may  be  congenital,  as  a  result  of  faulty  development  of  the 
vertebrae ;  frequently  it  is  caused  by  carrying  infants  on  the 
one  arm  and  in  the  same  position  at  all  times;  other  anatom- 
ical deformities,  such  as  shortness  of  one  leg,  dislocation  of 
the  hips,  genu  valgum,  contraction  of  one  side  of  the  chest 
as  a  result  of  empyema,  and  a  long  standing  torticollis ;  if 
the  lateral  curvature  is  due  to  shortening  of  one  of  the  legs, 
the  pelvis  is  tilted  downward  on  the  side  of  the  shorter  limb. 
and  results  in  a  lateral  curvature  in  the  lumbar  region,  with 
its  convexity  toward  the  shortened  extremity ;  at  the  same 
time  a  compensatory  curve  forms  in  the  dorsal  region  in 
the  opposite  direction.  When  the  curvature  is  due  to  empy- 
ema, it  is  located  primarily  in  the  dorsal  region,  with  its 
concavity  towards  the  affected  side  of  the  chest.  In  torti- 
collis the  curve  is  situated  in  the  cervical  region,  and  a  com- 
pensatory curve  follows  in  the  dorsal  region.  Another  fre- 
quent cause  of  lateral  curvature  is  standing  or  sitting  in  an 
incorrect  position,  namely,  throwing  the  weight  chiefly  on 
one  leg  when  standing,  or  leaning  constantly  to  one  side 
while  sitting.  Another  frequent  cause  of  lateral  curvature  is 
a  depraved  systemic  condition  which  is  present  so  frequently 
about  the  age  of  puberty,  as  a  result  of  rapid  growth  of  the 
individual,  combined  with  improper  food,  poor  hygienic  sur- 
roundings, or  overwork.  This  deformity  of  the  spine  is  also 
seen  in  young  women  suffering  from  chlorosis  and  amenor- 
.  rhea,  whose  occupation  requires  them  to  do  a  great  deal  of 
lifting. 

Symptoms  and  Signs. — The  nature  and  extent  of  the  de- 

551 


552  SPINAL  ADJUSTMENT 

formity  varies  considerably  in  different  cases.  The  most  coni- 
mon  condition  is  the  presence  of  two  curves,  one  of  which 
is  primary,  and  is  due  to  the  cause  of  the  affection,  while  the 
other  is  a  compensatory  curve,  formed  for  the  purpose  of 
maintaining  the  upright  axis  of  the  body.  The  form  which  is 
usually  seen  is  a  curvature  in  the  dorsal  region  with  the 
convexity  toward  the  right  side,  and  a  compensatory  curve, 
in  the  opposite  direction,  in  the  lumbar  region.  In  connection 
with  the  lateral  displacement  of  the  vertebrae  there  is  present 
rotation  of  the  vertebrae  in  the  affected  region.  This  rota- 
tion is  toward  the  side  of  convexity  of  the  curve.  As  a  direct 
consequence  of  this  rotation,  the  spinous  processes  of  the 
vertebrae  are  directed  away  from  the  convexity,  and  conse- 
quently minimize  the  apparent  extent  of  the  deformity.  Other 
portions  of  the  body  also  participate  in  the  deformity.  The 
ribs  on  the  side  towards  which  the  convexity  of  the  curve  is 
directed  are  separated  from  each  other,  and  are  more  promi- 
nent on  that  side,  as  a  result  of  the  rotation  of  the  vertebrae. 
At  the  same  time  the  ribs  on  the  affected  side  are  depressed^ 
and  the  front  of  the  chest  consequently  is  flat.  On  the  oppo- 
site side  the  ribs  are  pressed  toward  each  other,  the  scapulae 
are  displaced  in  the  same  direction  that  the  thoracic  wall  is, 
and  consequently  the  shoulder  on  the  side  of  the  convexity 
of  the  curve  is  raised  while  that  on  the  other  side  is  lowered. 
On  the  side  toward  which  the  curve  is  directed,  the  hip  is 
lower,  and  sunken  in,  while  on  the  opposite  side  the  hip  is 
raised  and  thrown  out.  The  erector  spinae  muscle  on  the 
side  of  the  concavity  of  the  curve  stands  out  very  prominent- 
ly, and  the  transverse  processes  on  this  side  are  also  plainly 
seen  in  many  cases.  In  the  early  stages  of  the  condition  the 
spine  may  be  made  to  appear  perfectly  straight  by  extension 
of  the  trunk ;  as  the  condition  progresses,  however,  ankylosis 
slowly  develops,  and  the  curve  becomes  fixed. 

Treatment. — The  first  requisite  in  the  treatment  of  these 
cases  is  the  determination  of  the  cause,  and  measures  directed 
towards  removal  thereof.  If,  for  example,  it  is  found  that  the 
condition  is  due  to  general  debility,  the  patient's  health  must 
be  improved  by  means  of  a  nutritious  diet,  well  regulated 
exercises,  baths,  and  massage.  If  the  condition  is  due  to 
faulty  habits  of  standing  or  sitting,  these  must  be  corrected. 


INJURIES  OF  SPINE  AND  DEFORMITIES  553 

Again,  if  it  is  clue  to  shortening  of  one  of  the  limbs, 
it  will  be  necessary  to  wear  a  high-heeled  boot  until  the 
manipulations  of  the  spine  and  adjustments  have  restored  it 
to  its  normal  position. 

Kyphosis 

Etiology. — An  increase  of  the  dorsal  convexity  of  the 
spine  is  very  frequently  associated  with  a  marked  increase 
in  the  lumbar  curve,  so  that  lordosis  is  present,  which  is  a 
compensatory  curve. 

This  condition  is  seen  frequently  in  various  diseases  of  the 
spinal  column,  especially  tuberculosis,  syphilis  and  cancer. 
It  also  follows  fractures  of  the  spine.  It  is  seen  frequently 
in  children,  under  the  age  of  five  years,  and  is  in  such  cases 
a  result  of  rickets.  In  youthful  persons,  up  to  the  age  of 
eighteen,  it  is  commonly  known  as  round-shoulders,  and  is 
brought  about  by  a  continuous  habit  of  bending  forward,  as 
in  reading  or  writing.  Different  occupations  predispose  to 
this  form  of  deformity,  such  as  those  which  necessitate  the 
carrying  of  heavy  loads,  or  work  which  requires  constant 
stooping  forward.  In  the  aged  it  is  a  compensatory  curve 
to  prevent  the  complete  closure  of  the  intervertebral  fora- 
mina, the  vertical  diameter  of  which  is  markedly  diminished, 
by  the  compression  of  the  intervertebral  discs. 

Symptoms. — The  symptoms  of  this  condition  have  been 
described  in  the  chapter  dealing  with  the  various  forms  of 
subluxation,  and  the  reader  is  referred  to  that  chapter. 

Treatment. — In  many  cases  ankylosis  of  the  vertebrae  has 
taken  place,  and  in  such  it  is  not  advisable  to  attempt  to  break 
the  ankylosis.  This  is  especially  true  if  the  spinal  deformity 
is  a  result  of  tuberculosis.  In  many  of  these  cases  the  focus 
of  tuberculosis  is  still  present,  though  not  active,  and  attempts 
at  breaking  the  ankylosis  very  often  produce  a  reaction  of 
inflammation  and  again  light  up  an  active  tuberculosis.  In 
the  aged,  a  kyphotic  curve  is  really  physiological,  and  should 
not  be  interfered  with.  When  due  to  various  occupations,  its 
occurrence  has  been  so  gradual,  and  the  curves  of  the  spine 
have  adapted  themselves  to  the  changed  position,  and  it  is 
therefore  inadvisable  to  attempt  to  change  them.  Where 
ankylosis  has  not  occurred,  it  is  possible  to  do  a  great  deal 
toward  the  correction  of  this  deformity  by  means  of  exten- 


554  SPINAL  ADJUSTMENT 

sion.  At  the  same  time  individual  subluxations  should  be 
corrected  as  indicated.  In  some  cases  surgical  measures  are 
indicated. 

Round  Shoulders 

Etiology. — This  condition  is  seen  most  commonly  in 
young  girls  who  have  grown  very  rapidly,  and  developed 
early.  It  is  usually  brought  about  by  faulty  habits  of  stand- 
ing or  sitting,  while  defective  vision  and  adenoids  may  also 
be  producing  factors.  The  spine  becomes  bent  forward  in 
the  lower  cervical  and  upper  dorsal  region,  while  the 
shoulders  are  also  thrown  forward  and  the  chest  is  narrowed. 

Treatment. — The  first  essential  in  the  treatment  is  to  as- 
certain the  cause  of  the  condition  and  correct  it.  The  general 
health  must  receive  attention,  and  plenty  of  fresh  air  and  a 
good,  nourishing  diet  must  be  provided.  Girls  aflfected  in 
this  way  should  never  exercise  to  excess,  and  should  spend 
several  hours  a  day  in  the  dorsal  position ;  at  night  they 
should  lie  on  the  back  with  a  pillow  placed  beneath  the  curve. 
The  muscles  of  the  back  should  be  strengthened  by  means  of 
electricity,  massage  and  well-directed  exercises.  Extension 
is  a  very  good  adjunct  measure  in  these  cases. 

Lordosis 

Etiology. — Lordosis  is  seen  most  commonly  in  the  lumbar 
region  of  the  spine.  It  is  commonly  a  compensation  curve 
in  cases  of  kyphosis.  It  is  very  often  due  to  congenital  dis- 
location of  the  hip,  or  to  diseases  of  the  hip-joint.  A  physi- 
ological lordosis  occurs  in  pregnancy ;  large  fibroid  tumors 
of  the  uterus  also  occasion  this  curve,  owing  to  the  necessity 
of  the  patient  throwing  backward  the  upper  part  of  the  spine, 
in  order  to  maintain  the  center  of  gravity  of  the  body.  A 
similar  condition  is  produced  in  the  same  way  in  individuals 
with  a  large,  pendulous  abdomen. 

Treatment. — The  measures  outlined  under  scoliosis  apply 
in  general  to  this  condition  also,  various  forms  of  manipulation 
being  essential  in  the  treatment. 

Spondylolisthesis 
Etiology. — This  is  a  deformity  in  which  the  lumbar  group 
of  vertebrae  are  displaced  forward  and  downward  upon  the 
sacrum.     Most  commonly  the  5th  lumbar  alone  is  thus  dis- 


INJURIES  OF  SPINE  AND  DEFORMITIES  555 

placed,  which,  in  reality,  constitutes  a  true  anterior  subluxa- 
tion of  this  vertebra.  When,  however,  the  term  "Spondy- 
lolisthesis" is  used,  it  is  meant  to  imply  that  the  entire  group 
of  lumbar  vertebrae  are  displaced  anteriorly  and  downward. 
The  condition  is  most  commonly  produced  by  the  carrying  of 
heavy  loads  upon  the  shoulders,  which  fact  explains  the  man- 
ner of  correction  of  an  anterior  displacement  of  the  5th  lumbar 
vertebra,  by  the  Bohemian  shoulder-thrust  method.  The  in- 
creased weight  of  the  uterus  during  pregnancy  may  also 
produce  this  deformity. 

Symptoms. — There  is  a  diminution  in  the  height  of  the 
individual,  and  a  depression  is  present  above  the  sacrum, 
while  at  the  same  time  the  lumbar  group  of  vertebrae  are 
seen  displaced  anteriorly.  Weakness  of  the  lower  part  of  the 
back,  and  neuralgic  or  rheumatic  pains  are  present. 

Treatment. — The   classical   treatment  of  this   affection   is 

by  spinal  adjustment.     When  only  the  5th  lumbar  vertebra 

is  afifected,  a  thrust  upon  the  sacrum  towards  the  feet  may 

alone    suffice    to    correct    it.      Sometimes    an    adjustment   of 

the  4th  lumbar  vertebra  in  the  direction  of  the  head  is  also 

necessary.       In    connection    with    this     treatment,    traction 

and  prolonged  rest  may  also  be  of  assistance   in  obstinate 

cases. 

Sprains  of  the  Spine 

Etiology. — Sprains  of  the  spine  are  exceedingly  common 
injuries,  and  are  responsible  for  a  great  number  of  the  sub- 
luxations, which  subsequently  are  followed  by  a  train  of  dis- 
eases and  disorders,  whose  nature  depends  upon  the  region 
of  the  spine  afifected.  They  are  produced  by  any  sudden  or 
unlooked-for  movements,  such  as  falls,  jars,  twists,  and  other 
movements.  The  cervical  and  lumbar  regions  of  the  spine 
are  most  apt  to  be  afifected  by  sprains.  In  some  cases  no 
actual  subluxations  are  produced,  and  the  injury  is  simply 
ligamentous  at  the  commencement,  but  later  on  spinal  lesions 
are  produced,  as  a  result  of  the  contraction  of  the  ligaments 
on  one  side. 

Symptoms. — The  characteristic  symptoms  are  those  of 
subluxation,  namely,  displacement  of  a  vertebra,  contraction 
of  the  ligaments,  local  heat,  tenderness  of  the  nerve,  and 
possibly  thickening  of  the  nerve  trunk.     There  may  also  be 


556  SPINAL  ADJUSTMENT 

evidences  of  trauma,  and  especially  bruising  of  the  surface, 
and  swelling  of  the  soft  tissues.  Sprains  of  the  spine  may  be 
very  simple,  or  they  may  be  extremely  severe ;  thus  merely 
the  muscles  and  the  interspinous  ligaments  may  be  involved, 
and  no  further  disorders  follow.  On  the  other  hand  the  liga- 
menta  subflava  may  be  torn  and  the  spinal  canal  laid  open, 
in  which  case  grave  symptoms  will  follow  by  reason  of  the 
blood  finding  its  way  into  the  spinal  canal,  and  producing 
pressure  upon  the  cord.  In  persons  of  a  tuberculous  diathe- 
sis, Pott's  disease  may  develop.  Sprains  of  the  cervical  por- 
tion of  the  spine  are  usually  a  result  of  violent  blows  upon  the 
head,  and  as  a  result  of  rupture  of  the  intertransverse  liga- 
ment, marked  displacement  of  the  vertebrae  may  be  occa- 
sioned, and  is  sometimes  so  severe  as  to  resemble  an  actual 
dislocation.  The  head  and  neck  are  held  perfectly  rigid,  and 
the  patient  is  unable  to  move  the  head  in  any  direction. 
Sprains  in  the  lumbar  region  of  the  spine  are  seen  very  fre- 
quently in  railway  injuries,  and  are  also  a  result  of  over- 
lifting.  In  these  cases  the  back  is  held  rigid,  and  the  patieht 
is  unable  to  turn  or  bend  forward  or  stoop  without 
experiencing  severe  pain. 

Treatment. — If  the  patient  is  seen  early  after  the  injury 
has  occurred,  absolute  rest  is  indicated  and  hot  applications 
should  be  used  over  the  afTected  parts  of  the  back.  As  soon 
as  inflammation  has  subsided,  and  the  pain  has  diminished, 
spinal  adjustments  should  be  used  as  indicated.  This  should 
be  followed  by  the  use  of  massage.  In  aggravated  sprains 
which  involve  the  cord,  cold  compresses  should  be  used  con- 
stantly, and  the  patient  placed  in  a  prone  position.  In  all 
cases  adjustment  should  be  made  as  soon  as  possible  after 
the  occurrence  of  the  injury. 

Dislocations  of  the  Spine 

Etiology .^ — A  dislocation  of  the  spine  is  a  complete  sepa- 
ration of  its  articular  processes,  and  all  its  contiguous  sur- 
faces. It  differs  from  a  subluxation  in  this,  namely,  that  in 
the  latter  there  is  only  a  partial  displacement  of  the  contigu- 
ous surfaces.  Many  dislocations  are  accompanied  by  frac- 
ture ;  in  the  cervical  region,  however,  a  pure  dislocation  can 
occur  without  being  associated  with  a  fracture.     The  reason 


INJURIES  OF  SPINE  AND  DEFORMITIES  55/ 

that  dislocations  may  occur  in  the  cervical  region  without 
fracture  is  due  to  the  shape  and  placement  of  the  articular 
processes,  which  in  this  region  are  flat,  and  slope  backward 
and  forward,  and  look  upward  and  downward,  so  that  it 
is  easily  possible  for  one  to  slip  over  the  other.  In  the  dor- 
sal region,  and  lumbar  region,  however,  complete  dislocation 
without  fracture  is  scarcely  possible,  for  the  reason  that  in 
the  dorsal  region  the  surfaces  of  the  articular  processes  are 
nearly  vertical  and  look  forward  and  backward ;  in  the  lumbar 
region  they  are  also  placed  vertically,  and  are  directed 
inward  and  outward  respectively,  and  fit  into  each  other  very 
accurately. 

Since  a  pure  dislocation  is  seen  most  commonly  only  in 
the  cervical  region,  dislocations  of  the  dorsal  and  lumbar 
region  will  not  be  considered  here,  but  will  be  described  under 
the  consideration  of  fractures  of  the  spine.  A  dislocation 
may  be  located  in  any  part  of  the  cervical  region ;  thus,  the 
atlas  may  be  displaced  from  the  occipital  bone,  and  if  com- 
plete, death  results  at  once.  A  dislocation  between  the  atlas 
and  axis  is  the  common  cause  of  death  in  hanging,  and  also 
occurs  following  blows  on  the  neck ;  in  nearly  all  these  cases 
the  transverse  ligament  is  torn,  or  the  odontoid  process  is 
fractured,  death  resulting  from  compression  of  the  medulla. 
Any  of  the  other  five  cervical  vertebrae  may  be  displaced 
from  each  other,  most  commonly  the  5th  and  6th.  It  is 
usually  produced  by  violent  bending  backward  of  the  head 
and  neck,  in  connection  with  rotation,  in  which  case  the  injury 
to  the  surrounding  soft  parts  is  very  extensive. 

Dislocation  of  this  kind  may  involve  either  one  side  of 
the  aflfected  vertebrae,  or  it  may  be  bi-lateral. 

Symptoms. — In  a  unilateral  dislocation  the  head  is  turned 
away  from  the  dislocated  side,  and  is  held  rigid,  and  no 
symptoms  of  injury  of  the  cord  are  present.  The  consequent 
pressure  of  the  margins  of  the  intervertebral  foramina  upon 
the  nerves,  produces  prickling  sensations,  and  neuralgic  pain 
along  the  course  of  the  nerves.  The  spinous  processes  of  the 
affected  vertebrae  are  displaced  to  one  side,  and  the  trans- 
verse processes  are  similarly  affected.  If  the  condition  is  not 
corrected  at  once,  it  becomes  permanent  and  various  disorders 
ensue,  depending  upon  the  location  of  the  dislocation. 


558  SPINAL  ADJUSTMENT 

In  a  bi-lateral  dislocation  there  are  always  present  symp- 
toms of  pressure  upon  the  cord,  such  as  paraplegia. 

Treatment. — In  severe  cases  the  patient  should  be  anaes- 
thetized in  order  to  produce  complete  relaxation  of  the  sur- 
rounding ligaments.  The  dislocation  is  then  corrected  by 
the  characteristic  chiropractic  thrust. 

Fractures  of  the  Spine 

Etiology. — Fractures  of  the  spine  are  a  result  of  direct 
or  indirect  violence.  They  are  of  two  kinds,  complete  and 
incomplete.  Complete  fractures  are  usually  associated  with 
dislocation,  and  are  often  referred  to  as  fracture-dislocations. 

Complete  fractures  may  be  produced  by  direct  or  indirect 
violence.  The  lesions  produced  may  be  of  various  kinds : 
Any  portion  of  the  body  of  the  vertebra  may  be  fractured,  or 
the  injury  may  involve  any  of  the  processes  of  the  vertebra. 
The  lower  fragment  is  usually  fixed,  while  the  upper  frag- 
ment is  movable  and  is  forced  forward  over  the  lower.  In 
nearly  all  cases  the  spinal  cord  is  seriously  injured  by  being 
crushed.  In  some  cases,  however,  the  injury  consists  merely 
in  a  puncturing  of  the  meninges  by  a  splinter  of  bone,  or  it 
may  consist  in  a  hemorrhage  of  the  meninges. 

Incomplete  fractures  are  of  various  kinds,  and  are  usually 
due  to  direct  violence.  Fracture  of  the  spinous  processes 
occurs  most  commonly  in  the  lower  cervical  and  in  the  dorsal 
regions  of  the  spine.  In  the  cervical  region  the  upper  cervical 
spinous  processes  are  very  short,  while  in  the  lumbar  region 
they  are  also  short  and  in  addition  to  this  fact,  are  very 
strong.  Fracture  of  the  laminae  is  not  unusual;  if  both  lam- 
inae are  fractured  there  is  a  forward  displacement  of  the  up- 
per fragment  and  a  crushing  injury  of  the  spinal  cord  en- 
sues. If  only  one  lamina  is  fractured,  the  cord  is  usually  left 
uninjured,  and  the  signs  of  the  fracture  are  indistinct.  Frac- 
ture of  the  transverse  processes  alone  is  an  uncommon  injury. 
Fractures  of  the  bodies  of  the  vertebrae  when  incomplete, 
are  accompanied  by  no  displacement  of  the  fractured  portion, 
and  little  after  effects  result. 

Symptoms. — The  signs  of  a  complete  fracture  are  pain. 
swelling,  deformity,  crepitation,  shock  and  paraplegia.  The 
signs  of  incomplete  fracture  are  pain,  swelling,  increased  mo- 


INJURIES  OF  SPINE  AND  DEFORMITIES  559 

bility,  and  sometimes  crepitation,  together  with  mal-alignment 
of  the  spinous  processes  in  some  instances. 

Treatment. — The  treatment  of  a  complete  fracture  con- 
sists first  of  all  in  placing  the  patient  on  a  hard  bed,  which 
is  perfectly  level.  When  the  patient  is  seen  immediately 
after  the  injury  has  occurred,  the  greatest  care  should  be  ex- 
ercised in  moving  him  so  as  not  to  aggravate  the  displace- 
ment of  the  fractured  portions.  Severe  shock  should  be 
treated  by  the  use  of  warm  application's  and  stimulants.  When 
the  reaction  of  inflammation  and  the  severe  pain  have  some- 
what subsided,  a  careful  analysis  of  the  spine  should  be  made. 
In  some  cases  an  adjustment  under  an  anesthetic  will  suffice 
to  replace  the  fractured  fragments.  Following  this  complete 
rest  in  bed  should  be  had  for  a  long  period  of  time,  during 
which  careful  attention  should  be  given  to  the  condition  of  the 
skin,  bowels  and  bladder.  The  tendency  toward  bed-sores  is 
marked,  and  everything  should  be  done  to  harden  the  skin, 
and  thus  prevent  their  occurrence.  The  bladder  is  very  often 
paralyzed,  and  the  urine  must  be  withdrawn  by  means  of  a 
catheter.  The  bowels  have  a  tendency  toward  constipation 
and  daily  enemata  are  necessary. 

The  treatment  of  incomplete  fractures  consists  chiefly  in 
keeping  the  patient  at  rest  for  a  prolonged  period,  during 
which  time  union  of  the  fractured  portions  take  place. 

Tuberculosis  of  the  Spine  (Pott's  Disease) 

Etiology. — Tuberculosis  of  the  spine  is  caused  primarily 
by  a  low  grade  of  resistance,  due  to  faulty  innervation,  by 
reason  of  which  the  individual  is  predisposed  to  the  con- 
tributing causes  of  the  disease,  which  are  infection  by  tubercle 
bacilli.  Usually  the  actual  occurrence  of  the  disease  process 
dates  from  the  time  of  an  injury;  this  injury  may  not  be 
sufficient  to  occasion  any  trouble  at  the  time,  and  no  symp- 
toms may  develop  until  six  months  to  a  year  after  the  occur- 
rence of  the  traumatism.  Tuberculosis  of  the  spine  is  seen 
most  commonly  in  children,  but  may  occur  at  any  age.  It 
may  afifect  any  portion  of  the  spinal  column,  though  the  lower 
dorsal  region  is  most  commonly  involved. 

Pathology. — The  disease  process  commences  in  the  bodies 
of  the  vertebrae,  and  spreads  to  neighboring  vertebrae  either 


560  SPINAL  ADJUSTMENT 

along  the  under  surface  of  the  anterior  common  ligaments,  or 
by  way  of  the  intervertebral  discs.  When  the  process  ex- 
tends along  the  anterior  common  ligaments  many  vertebrae 
may  be  afifected,  and  the  deformity  which  results  is  in  the 
nature  of  a  kyphosis.  When  the  process  extends  along  the 
intervertebral  discs,  it  is  not  so  extensive,  fewer  vertebrae 
are  involved,  and  an  angular  deformity  results.  The  active 
process  is  finally  terminated  by  the  bodies  of  the  vertebrae 
collapsing  and  becoming  ankylosed,  resulting  in  a  deformed 
and  immovable  condition  of  the  involved  portion  of  the  spine. 

Symptoms. — The  characteristic  symptoms  of  Pott's  disease 
are  pain,  which  is  continuous,  and  of  two  kinds :  First,  a 
local  pain  which  is  experienced  at  the  site  of  the  lesion  and 
is  of  a  boring  nature ;  second,  referred  pain,  which  is  felt  at 
the  terminals  of  the  spinal  nerves  which  are  impinged  as  they 
emerge  through  the  intervertebral  foramina.  Spinal  rigidity 
is  a  constant  symptom  of  Pott's  disease,  and  in  the  early  stages 
is  due  to  the  muscular  contraction,  which  accompanies  the 
local  inflammation.  In  all  cases  deformities  result,  as  above 
described,  the  patient's  stature  is  much  diminished,  the 
sternum  is  thrown  forward,  the  upper  ten  ribs  are  approxi- 
mated so  that  the  intercostal  spaces  are  practically  obliterated, 
while  the  lower  two  ribs  are  in  their  normal  position,  and  a 
horizontal  groove  is  thus  formed  on  a  line  with  the  10th  rib. 
The  most  serious  efifects  of  tuberculous  disease  is  abscess 
formation.  The  abcess  is  not  felt  until  it  has  reached  a  con- 
siderable size  and  has  burrowed  for  some  distance  into  sur- 
rounding structures  and  parts. 

Treatment. — The  treatment  of  Pott's  disease  consists  in 
complete  immobilization  of  the  spine,  together  with  the  ap- 
plication of  a  mechanical  support,  which  has  for  its  object  the 
removal  of  the  weight  of  the  body  from  the  affected  portion 
of  the  spine.  For  the  technique  of  the  various  methods  of 
immobilizing  the  spine,  the  reader  is  referred  to  text-books 
on  surgery. 

Syphilitic  Disease  of  the  Spine 

Symptoms. — Syphilis  of  the  spine  occurs  in  the  tertiary 
stage  of  syphilis,  and  consists  in  the  deposition  of  gummata 
on  the  bodies  of  the  vertebrae  beneath  the  periosteum.  The 
general  symptoms  are  similar  to  those  of  tuberculosis  of  the 


INJURIES  OF  SPIxNE  AND  DEFORMITIES  -561 

spine.     The    lesion   occurs   most   commonly    in   the   cervical 
region  of  the  spine. 

Treatment. — The  treatment  consists  in  the  use  of  elimina- 
tive  measures,  rest,  and  the  application  of  a  spinal  support. 

Rheumatic  Spondylitis 

Etiology. — This  condition  is  the  same  as  that  occurring  in 
any  portion  of  the  body  affected  by  rheumatism.  The  liga- 
ments and  muscles  of  the  spine  are  usually  afifected,  although 
the  intervertebral  discs  may  also  be  the  seat  of  rheumatic  in- 
flammation.   It  is  most  commonly  noted  in  the  cervical  region. 

Symptoms. — The  movements  of  the  head  and  neck  are 
much  impaired,  and  lateral  deflection  of  the  neck,  such  as 
occurs  in  torticollis,  is  often  present.  In  cases  which  are  left 
untreated,  ankylosis  finally  develops. 

Treatment. — The  treatment  is  the  same  as  that  for  rheu- 
matism in  any  portion  of  the  body. 

Osteoarthritis  of  the  Spine 

Symptoms. — Osteoarthritis  may  afifect  the  entire  vertebral 
column,  and  ankylosis  usually  occurs.  In  most  cases  kyphosis 
develops,  and  intense  pain  is  present  due  to  the  pressure  of 
the  bony  outgrowths  upon  the  nerve  roots.  The  condition 
may  remain  confined  to  the  spine  or  may  extend  to  othei 
portions  of  the  body. 

Treatment. — The  treatment  of  osteoarthritis  of  the  spine 

is  the  same  as  that  of  the  disease  in  other  portions  of  the 

body. 

Acute  Osteomyelitis  of  the  Spine 

Etiology. — The  primary  and  predisposing  cause  of  this 
afifection  is  a  low-grade  of  resistance  due  to  faulty  innerva- 
tion. The  direct  cause  is  an  infection  with  pus-producing 
organisms,  in  the  face  of  this  low  resistance. 

Symptoms. — The  characteristic  symptoms  of  osteomyelitis 
of  the  spine  are  pain  of  an  intense  and  boring  character  in  the 
afifected  portions  of  the  spine  and  radiating  over  the  back ; 
alternating  chills  and  fever;  early  in  the  course  of  the  disease 
abscesses  develop,  which  may  burrow  into  the  spinal  canal, 
which  is  a  common  complication. 

Treatment.— The  treatment  of  this  aifection  is  limited  to 
surgical  measures. 


562  SPINAL  ADJUSTMENT 

Genu  Valgum  (Knock-knee) 

Etiology. — There  are  two  varieties  of  this  deformity: 
First,  that  form  which  is  seen  in  young  children,  and  which 
is  due  to  rickets;  second,  that  form  which  is  seen  in  individ- 
uals under  the  age  of  20  years,  and  which  is  due  to  general 
debility,  and  in  addition  is  brought  about  by  the  carrying  of 
heavy  weights,  being  seen  especially  in  nurse-maids,  janitors, 
etc. 

Symptoms. — The  thighs  approach  each  other  until  the 
knees  touch,  while  the  patellae  look  forward,  and  at  the  same 
time  the  legs  are  in  a  state  of  fixed  abduction.  One  or  both 
limbs  may  be  affected,  although  if  the  condition  is  due  to 
general  causes,  both  limbs  are  usually  affected. 

Treatment. — In  children  suffering  from  rickets  the  treat- 
ment is  confined  principally  towards  the  correction  of  that 
disease.  For  this  purpose  plenty  of  fresh  air,  hygenic  meas- 
ures, and  a  nourishing  diet  are  indicated.  At  the  commence- 
ment of  the  treatment  the  patient  should  be  confined  to  bed, 
and  massage,  passive  movements,  and  manipulation  used  in 
order  to  straighten  the  limb.  At  the  same  time  general  ad- 
justments should  be  given.  When  the  deformity  has  existed 
for  a  long  time,  or  is  very  marked,  various  corrective  ap- 
pliances or  even  surgical  measures  are  necessary  to  produce 
a  cure. 

Talipes  (Club-foot) 

Etiology. — This  deformity  may  be  either  congenital  or 
acquired. 

The  congenital  form  may  result  from  faulty  development 
of  the  bones  of  the  foot  or  leg,  or  from  a  deficiency  in  the 
amount  of  the  amniotic  fluid,  as  a  result  of  which  the  feet  are 
held  in  one  position.  This  form  is  often  hereditary  and  is 
seen  in  several  members  of  one  family. 

The  acquired  form  is  frequently  due  to  infantile  paralysis, 
contraction  of  muscles  following  burns  or  infection,  long  con- 
tinued spasm  of  the  muscles,  shortening  of  the  leg  from  hip 
or  knee  disease,  the  habit  of  standing  with  the  foot  in  an 
awkward  position,  and  diseases  of  the  main  peripheral  nerves. 

Symptoms. — Four  main  forms  of  Talipes  are  commonly 
seen:     First,  Talipes  Varus,  in  which  the  front  half  of  the 


INJURIES  OF  SPINE  AND  DEFORMITIES  563 

foot  is  adducted,  while  its  inner  side  is  elevated,  the  patient 
thus  walking  on  the  outer  side.  Second,  Talipes  Valgus,  in 
which  the  front  half  of  the  foot  is  adducted  and  turned  out, 
so  that  the  patient  walks  on  the  inner  side  of  the  foot.  Third, 
Talipes  Equinus,  in  which  the  heel  is  drawn  up,  so  that  the 
patient  walks  on  the  toes.  Fourth,  Talipes  Calcaneus,  in 
which  the  toes  are  raised  from  the  ground,  and  the  patient. 
walks  on  the  heel.  Various  combinations  of  these  forms  may- 
be seen. 

Treatment. — In  the  congenital  variety  treatment  should 
be  commenced  as  soon  after  birth  of  the  child  as  possible. 
The  foot  must  be  manipulated  daily  into  a  good  position,  in 
addition  to  which  forcible  attempts  should  be  made  at  cor- 
rection. The  muscles  of  the  foot  and  leg  should  be  massaged 
thoroughly,  and  the  faradic  current  should  be  used.  Later 
on  mechanical  appliances  and  the  use  of  surgical  measures 
are  often  necessary.  When  the  condition  is  due  to  infantile 
paralysis,  general  adjustments,  massage,  and  electrical  treat- 
ments are  the  proper  measures  to  be  used.  The  other  form 
should  be  corrected  by  manipulation,  massage,  electricity  and 
adjustments,  and  those  cases  which  will  not  respond  to  this 
method  of  treatment  should  be  referred  to  the  surgeon. 

Flat-foot 

Etiology. — This  deformity  is  seen  chiefly  in  young  adults 
whose  occupation  requires  them  to  spend  long  hours  standing 
on  the  feet.  It  is  also  a  result  of  a  general  muscular  relaxa- 
tion and  loss  of  tone  which  follows  debilitating  diseases.  It 
is  seen  more  commonly  in  long  than  in  short  feet,  and  it  seems 
to  be  a  natural  condition  among  some  of  the  negro  races. 

Symptoms. — In  the  early  stages  of  the  condition  the 
patient  complains  of  weakness  and  fatigue  along  the  inner 
side  of  the  foot  or  ankle.  Later  on  the  gait  becomes  shuffling 
and  marked  pain  is  present  over  the  entire  foot.  The  sole  of 
the  foot  is  flat,  and  in  advanced  cases  is  in  contact  with  the 
floor  throughout  its  entire  extent.  A  diagnosis  of  the  con- 
dition can  readily  be  made  by  having  the  patient  stand  on  a 
piece  of  smoked  paper,  and  obtaining  the  imprint  of  the  foot. 

Treatment. — In  the  early  stages,  before  the  deformity  has 
become  fixed,  the  first  consideration  is  rest  of  the  affected 


564  SPINAL  ADJUSTMENT 

feet.  This  permits  the  exhausted  and  over-strained  ligaments 
and  muscles  to  regain  their  normal  strength  and  tonicity.  At 
the  same  time  the  parts  should  be  thoroughly  massaged  and 
manipulated,  in  order  to  build  up  the  arch  of  the  foot  again. 
Exercises  should  be  used,  the  best  of  which  consist  in  having 
the  patient  raise  himself  on  the  toes,  and  move  up  and  down 
20  times  without  permitting  the  heels  to  strike  the  floor. 
This  should  be  done  every  morning  and  has  for  its  object  the 
strengthening  of  the  plantar  muscles.  In  addition  to  these 
measures  of  treatment,  adjustments  in  the  lumbar  region 
often  prove  wonderfully  successful.  The  patient  should  wear 
proper  shoes,  and  if  necessary,  an  arch  should  be  inserted  to 
support  the  foot.  If  the  deformity  is  fixed,  surgical  measures 
may  be  necessary  to  forcibly  correct  it. 

Torticollis 

Etiology. — Torticollis  or  Wry-neck  is  a  deformity  due 
primarily  to  a  contraction  of  the  sterno-mastoid  and  trapezius 
muscles  of  one  side,  as  a  result  of  irritation  of  the  nerves 
which  control  them.  It  is  secondarily  due  to  exposure  tc 
cold,  rheumatism,  and  hysteria. 

Symptoms. — The  affected  side  of  the  head  is  drawn  down 
toward  the  shoulder,  and  at  the  same  time  the  face  is  turned 
away  therefrom.  The  cervical  portion  of  the  vertebral  column 
is  scoliotic,  with  the  concavity  of  the  curve  directed  toward 
the  afifected  side.  Coincidently  with  this,  a  compensation 
curve  forms  in  the  dorsal  region,  which  is  chiefly  for  the  pur- 
pose of  maintaining  the  eyes  at  the  same  level.  Later  on 
the  muscles  of  the  affected  side  of  the  face  and  neck  become 
atrophied. 

Treatment. — Adjust  the  cervical  vertebrae.  Massage  and 
electricity  are  useful  adjunct  measures  in  these  cases. 

Diseases  of  the  Joints 

For  a  detailed  discussion  of  the  various  diseases  of  the 
joints,  the  reader  is  referred  to  text-books  on  surgery.  It 
may,  however,  be  mentioned  in  this  connection,  that  spinal 
adjustment  is  often  extremely  successful  in  the  treatment  of 
various  joint  affections,  and  should  in  all  cases  be  given  a 
thorough  trial. 


CHAPTER  XV 

Diseases   of  the   Skin 

Many  of  these  cases  belong  to  the  specialist,  and  should 
be  referred  to  a  dermatologist.  There  are  a  number  of 
dermatoses  however,  which  respond  to  methods  of  therapy 
other  than  the  use  of  drugs  and  these  can  be  successfully 
managed  by  the  general  practitioner. 

In  the  consideration  of  this  subject  it  will  be  necessary  to 
confine  ourselves  to  generalities  since  it  is  obviously  im- 
possible in  a  work  of  this  nature  to  give  a  detailed  description 
of  each  disease.  Skin  diseases  have  been  so  minutely  classified 
and  so  variously  named  that  skill  in  diagnosis  of  each  individ- 
ual disease  can  be  acquired  only  by  long  experience. 

The  treatment  of  these  diseases  is  identical  in  many  cases, 
and  varies  with  the  nature  of  the  local  lesions,  the  acuteness 
or  chronicity  of  the  condition,  and  whether  systemic  or  local 
in  origin ;  symptomatic  therapy  is  often  indicated. 

Etiology. — Diseases  of  the  skin  are  due  to  a  great  variety 
of  causes,  the  most  important  of  which  is  subluxation  of  the 
vertebrae  by  which  the  innervation  of  the  skin  is  made  de- 
ficient. As  a  result  of  this,  it  sufifers  nutritional  disturbances, 
its  functional  activity  is  impaired,  and  the  low  grade  of  re- 
sistance which  is  thereby  induced,  renders  it  susceptible  to 
the  invasion  of  the  contributing  causes,  which  are  as  follows: 

The  contributing  or  exciting  causes  of  skin  diseases  are 
of  two  classes:     First,  internal;  second,  external. 

The  internal  causes  of  dermatoses  are,  first,  drugs,  foods, 
bacteria,  and  infections.  Second,  various  neuroses,  reflex 
nervous  derangements  and  emotional  disorders.  Third,  nu- 
tritional disturbances. 

The  external  causes  of  skin  diseases  are  chemical,  thermal, 
mechanical,  and  parasitic. 

Other  predisposing  causes  to  various  dermatoses  in  addi- 
tion to  general  impairment  of  the  health  as  a  result  of  subluxa- 

565 


566  SPINAL  ADJUSTMENT 

tions  are,  first,  age;  second,  sex;  third,  nationality  or  race; 
fourth,  climate  and  seasons;  fifth,  occupation  and  mode  of 
living;  sixth,  susceptibility,  predisposition,  diathesis,  or 
idiosyncracies  of  the  individual. 

Symptoms  and  Diagnosis. — "Extent  of  surface  involved — 
In  making  the  general  inspection,  attention  must  also  be  paid 
to  the  amount  of  surface  involved  and  to  the  localities  occupied 
by  the  eruption.  In  addition  to  the  illustration  just  given,  it 
should  be  recalled  that  exanthemas  usually  cover  the  whole 
body;  that  the  early  syphilids  are  w^idely  distributed;  that 
acne  is  seated  upon  the  face  and  shoulders ;  that  psoriasis  is 
likely  to  be  symmetrically  disposed ;  and  that  tinea  versicolor 
is  found  on  the  trunk,  xanthoma  on  the  lids,  lupus  and 
epithelioma  generally  on  the  face,  and  lupus  erythematosus 
on  the  nose  and  cheeks. 

Arrangement  of  Lesions. — It  is  important  to  know  whether 
the  lesions  occupy  one  or  both  sides  of  the  body,  and  whether 
they  possess  any  special  arrangement.  For  example,  in  zoster 
the  eruption  is  unilateral  and  the  eruptive  elements  follow  the 
course  of  cutaneous  nerves,  displaying  clusters  of  vesicles  on 
a  red  base.  In  ringworm  the  lesions  afifect  a  ringed  arrange- 
ment, and  extend  at  the  periphery  while  clearing  in  the  center. 
This  disposition  is  also  to  be  noted  in  psoriasis  and  in  some 
syphilids;  herpes  iris  is  annular.  Moreover  the  eruption  in 
syphilis  is  often  grouped — a  feature  also  to  be  observed  in 
dermatitis  herpetiformis ;  but  the  first-mentioned  afifection 
presents  no  marked  subjective  symptoms,  whereas  in  the 
latter  there  are  intolerable  itching  and  burning. 

Color. — The  color  of  an  eruption  is  often  at  least  an 
auxiliary  aid  to  diagnosis.  The  brownish-red  or  ham  color 
of  some  syphilids  differs  from  the  underlying  brighter  red  of 
psoriasis,  and  it  also  may  be  said  that  the  thick  greenish 
crusts  of  syphilis  are  fairly  characteristic.  The  favus  cups 
are  sulphur-yellow ;  the  patches  of  tmea  versicolor  are  of  a 
fawn-tint;  keloidal  tumors  are  pinkish;  and  the  new  growths 
of  xanthoma  are  buflf-colored.  In  the  same  way  the  shade  of 
color  presented  by  an  inflammation  of  the  skin  will  measur- 
ably indicate  its  acute  or  chronic  character. 

Touch. — The  affected  skin  should  also  be  pinched  up  be- 
tween the  fingers,  or  in  order  to  get  as  accurate  an  idea  as 


DISEASES  OF  THE  SKIN  567 

possible  of  the  amount  of  infiltration  present,  the  special 
tissues  involved,  the  temperature,  the  presence  or  absence  of 
fluctuation,  etc.  An  account  of  the  symptoms  revealed  by  the 
educated  touch  will  often  determine  whether  a  disease  is 
superficial  or  deep-seated,  and  thus  eliminate  whole  groups 
of  disorders  from  the  field  of  discussion. 

Odor. — The  odors  arising  from  certain  diseases  of  the 
skin  are  at  times  helps  to  their  diagnosis.  Favus  has  a  pecu- 
liar mouse-nest  smell ;  syphilitic  ulceration  emits  a  nauseating 
stench  that  is  suggestive ;  while  the  smell  of  gangrene  is  well 
recognized. 

Acute  or  Chronic. — The  objective  aspect  of  the  disease  is 
indicated  by  these  terms  rather  than  the  time  occupied  in  its 
development,  the  latter  point  receiving  notice  more  particu- 
larly when  the  previous  history  of  the  case  is  under  inquiry. 
For  example,  an  eczema  may  have  an  acute  appearance 
although  a  long  time  in  existence,  while  a  syphilid  may  be  of 
recent  origin  yet  lack  all  evidence  of  acuteness.  Any  changes 
that  may  have  occurred,  such  as  crusting,  scarring  and  the 
like,  should  be  carefully  noted,  and  the  extending  or  outer 
margin  of  a  patch  should  be  especially  observed,  as  often  in 
this  way  we  may  detect  the  primary  lesions  (e.  g.,  in  lupus) 
of  an  eruption  that  has  been  disguised  by  complications  of 
treatment. 

Individual  Lesions. — It  so  happens  that  diseases  of  the 
skin,  whatever  may  be  their  cause  or  nature,  impress  them- 
selves upon  the  integument  by  certain  elementary  forms  called 
primary  lesions,  which  have  been  justly  termed  the  alphabet 
of  dermatology ;  and  there  are  also  to  be  observed  certain 
other  manifestations  that  are  partly  the  sequels  of  the  initial 
processes  or  are  the  efifect  upon  them  of  traumatism — these 
are  termed  secondary  lesions.  The  primary  lesions  consist 
of  macules,  papules,  vesicles,  blebs,  pustules,  tubercles,  wheals 
and  tumors. 

Macules  are  discolored  patches  of  skin,  of  variable  shape 
and  size,  without  elevation  or  depression. 

Papules  are  circumscribed  solid  elevations  of  the  skin, 
varying  in  size  from  that  of  a  pinhead  to  that  of  a  pea. 

Vesicles  are  pinhead-sized  to  a  pea-sized  circumscribed 
elevations  of  the  epidermis,  containing  clear  or  opaque  fluid. 


568  SPINAL  ADJUSTMENT 

Blebs  are  round  or  irregular  shaped  pea-sized  to  egg-sized 
elevations  of  the  epidermis,  containing  clear  or  opaque  fluid. 

Pustules  are  circumscribed,  flat,  or  accuminate  elevations 
of  the  epidermis,  containing  pus. 

Wheals  are  edematous,  circumscribed,  irregular,  pinkish 
elevations  of  the  skin,  transitory  in  character. 

Tubercles  are  circumscribed,  solid,  deep-seated  elevations 
of  the  skin,  attaining  or  exceeding  the  size  of  a  pea. 

Tumors  are  variously  sized  and  shaped  prominences,  hav- 
ing their  seat  in  the  coTium  or  subcutaneous  tissue. 

The  secondary  lesions  comprise  scales,  crusts,  excoriations, 
fissures,  ulcers,  scars,  and  stains. 

Scales  are  dry  epidermal  exfoliations  shed  from  the  sur- 
face of  the  skin. 

Crusts  are  brownish  or  yellowish  masses  of  dried  exuda- 
tion. 

Excoriations  are  epidermal  denudations,  usually  the  result 
of  local  traumatism. 

Fissures  are  linear  cracks  or  wounds  in  the  epidermis  or 
corium  due  to  disease  or  injury. 

Ulcers  are  round  or  irregular  losses  of  tissue  involving 
the  skin  and  subcutaneous  tissue. 

Scars  are  connective  tissue  new  formations  occupying  the 
region  of  former  losses  of  tissue. 

Stains  are  discolorations  of  the  skin  left  after  the  disap- 
pearance of  cutaneous  lesions. 

While  it  is  absolutely  necessary  for  one  desiring  a  knowl- 
edge of  dermatology  to  know  thoroughly  these  pathologic 
processes,  it  is  not  claimed  that  the  recognition  of  a  primary 
or  secondary  lesion  will  immediately  give  a  clue  to  the  diag- 
nosis ;  for  it  is  well  known  that  these  lesions  are  due  to  the 
most  varied  morbid  states,  and  that  the  same  kind  of  lesions 
will  often  be  found  in  very  dissimilar  diseases.  If,  however, 
the  type  of  the  lesion  has  been  determined,  at  least  the  field 
of  investigation  has  been  considerably  narrowed.  For  in- 
stance, it  is  of  decided  advantage  to  be  aware  that  in  herpes 
zoster  there  are  vesicles  and  not  tubercles ;  that  in  a  disorder 
presenting  macules  we  have  not  to  deal  with  pemphigus  or 
acute  urticaria,  for  these  afifections  are  characterized  by  an 
entirely  different  order  of  lesions.    The  same  reasoning  holds 


DISEASES  OF  THE  SKIN  569 

good,  in   a  measure,   for  secondary  lesions,   such   as   crusts, 
ulcers,  scars,  scales,  etc. 

Macules  occur  in  chloasma,  eczema,  erysipelas,  roseola, 
rubeola,  scarlatina,  rotheln,  erythema,  ephelis,  leukoderma, 
melanoderma,  tinea  versicolor,  syphilis,  xanthoma,  purpura, 
naevus  pigmentosus,  and  morphea.  When  a  large  portion 
or  the  entire  skin  is  involved  by  change  of  color,  it  is  known 
as  a  discoloration ;  such,  for  example,  as  is  seen  in  Addison's 
disease,  leprosy,  and  argyria. 

Papules  are  observed  in  acne,  milium,  comedo,  eczema, 
lichen,  prurigo,  in  certain  kinds  of  purpura  and  urticaria  and 
in  variola,  keratosis  pilaris,  ichthyosis,  and  miliaria  papulosa. 
The  eruptions  of  measles  and  rotheln  are  really  maculopapular 
in  character.  In  syphilis  the  papule  is  often  surmounted  by  a 
scale. 

Tubercles  are  found  in  connection  with  syphilis,  leprosy, 
parasitic  sycosis,  acne,  molluscum  epitheliale,  and  lupus. 

Tumors  exist  in  carcinoma,  sarcoma,  syphilis,  elephantia- 
sis, angioma,  keloid,  lipoma,  fibroma,  and  erythema  nodosum. 

Vesicles  are  present  in  eczema,  herpes,  vaccinia,  sudamen, 
miliaria,  varicella,  dermatitis,  dysidrosis,  scabies ;  vesicopus- 
tules  are  observed  in  impetigo  contagiosa,  the  vesicular 
syphilid,  etc. 

Blebs  occur  in  pemphigus,  hydroa,  erysipelas,  herpes  iris, 
leprosy,  syphilis  and  dermatitis. 

Pustules  are  encountered  in  acne,  variola,  ecthyma,  equinia, 
impetigo,  scabies,  syphilis,  sycosis,  dermatitis,  and  pustula 
maligna. 

Wheals  are  found  in  connection  with  irritable  states  of 
the  skin,  such  as  occur  from  the  bites  of  insects  and  most 
typically  in  urticaria,  and  also  in  some  degree  with  purpura 
and  erythema  multiforme. 

Scales  are  observed  in  psoriasis,  eczema,  pityriasis  rubra, 
exfoliative  dermatitis,  scarlet  fever,  measles,  seborrhea,  the 
vegetable  parasitic  afifections,  and  ichthyosis. 

.  Crusts  are  to  be  found  in  eczema,  syphilis,  scabies, 
ecthyma,  scrofuloderma,  leprosy,  impetigo,  carcinoma,  sebor- 
rhea, herpes  zoster,  and  sycosis. 

Fissures  occur  in  eczema,  psoriasis,  syphilis,  ichthyosis, 
verruca. 


570  SPINAL  ADJUSTMENT 

Excoriations  are  to  be  seen  in  prtiriginous  disorders,  such 
as  eczema,  pruritis,  pediculosis,  scabies,  etc. 

Ulcers  appear  as  sequels  to  the  lesions  of  syphilis,  lupus, 
boils,  carbuncles,  eczema,  herpes  zoster,  scrofulo-derma, 
epithelioma,  sarcoma. 

Scars  come  in  the  wake  of  ulcerative  skin-diseases ;  e.  g., 
lupus  vulgaris,  syphilis  and  lupus  erythematosus. 

Having  now  closely  observed  all  that  the  eye,  the  touch, 
the  sense  of  smell,  etc.,  can  reveal — in  other  words,  having 
made,  free  from  preconceived  notions,  a  thorough  study  of 
the  objective  symptoms  present — we  are  better  prepared  to 
ascertain  the  general  history  of  the  case,  to  obtain  an  account 
of  the  patient's  own  sensations,  and,  finally,  to  make  use  of 
the  various  collateral  methods  of  diagnosis  that  science  has 
placed  at  our  disposal. 

Locality. — Many  diseases  have  distinct  predilections  for 
special  localities.  Psoriasis  elects  the  scalp  and  the  extensor 
surfaces  of  the  elbows  and  knees.  Eczema  may  occur  any- 
where, but  prefers  the  flexor  surfaces.  The  excoriations  of 
pediculosis  corporis  are  seen  across  the  shoulder-blades  and 
around  the  waist.  Acne  attacks  the  face  and  chest.  The 
lesions  of  scabies  are  quite  constantly  present  on  the  webs 
and  sides  of  the  fingers,  the  flexor  surfaces  of  the  wrists,  the 
anterior  and  posterior  axillary  folds,  the  nipples,  the  umbilicus, 
the  penis,  the  buttocks,  the  inner  sides  of  the  thighs  and  legs, 
and  the  toes  (in  infants).  The  face  is  always  exempt,  except 
in  infants.  Erythema  multiforme  attacks  the  face,  the  neck, 
and  the  back  of  the  hands  and  feet.  Erythema  nodosum  is 
usually  situated  on  the  anterior  surfaces  of  the  tibias.  The 
proneness  of  common  afifections  to  attack  special  localities 
is  indicated  in  the  following  list : 

Scalp — Eczema,  ringworm,  pediculosis  capitis,  favus, 
seborrhea,  alopecia  areata. 

Face — Acne,  eczema,  lupus  vulgaris,  lupus  erythematosus, 
syphilis,  impetigo,  sycosis. 

Chest — Tinea  versicolor,  seborrheic  eczema,  macukr 
syphiloderm,  acne. 

Shoulders  and  Back — Acne,  carbuncle,  pediculosis  corporis. 

Buttocks — Furuncles,  scabies,  congenital  syphilis,  eczema 
intertrigo. 


DISEASES  OF  THE  SKIN  571 

Genitals — Eczema,  pruritus,  herpes  simplex,  scabies, 
syphilis. 

Lower  extremities — Purpura,  ecthyma,  eczema  rubrum, 
erythema  nodosum. 

Age,  Sex  and  Social  Condition. — Some  diseases  of  the  skin 
are  more  prone  to  attack  children  than  adults,  and  vice  versa. 
Epithelioma  usually  appears  first  in  middle  or  advanced  life, 
while  lupus  vulgaris  nearly  always  dates  from  childhood. 
Neither  acne  nor  tinea  versicolor  is  common  in  children,  but 
ringworm  of  the  scalp  shows  a  predilection  for  that  age  and 
usually  spares  the  adult.  Ichthyosis  is  practically  congenital. 
Lupus  erythematosus  is  more  frequent  in  women,  and 
epithelioma  of  the  lower  lip  is  generally  an  affection  of  the 
male.  V    i 

A  knowledge  of  the  occupation  is  sometimes  a  help  in 
diagnosis.  Bakers,  grocers,  bricklayers,  plasterers,  and  bar- 
keepers suffer  from  eczema,  and  artisans  who  handle  chemicals 
and  other  irritants  exhibit  various  grades  of  dermatitis. 
Hostlers  may  contract  glanders,  and  wool-sorters  become  in- 
fected with  anthrax.  Pediculosis  is  more  common  in  the  poor 
and  unclean  than  in  the  upper  classes  of  society. 

Antecedent  History. — The  past  history  of  the  case  will  in- 
form us  as  to  former  attacks  of  cutaneous  or  other  diseases ; 
and  if  the  information  is  judiciously  elicited,  may  throw  much 
light  on  the  present  condition.  This  is  of  prime  importance, 
especially  in  syphilis. 

General  Symptoms.- — The  general  symptoms  of  the  patient 
must  not  be  neglected.  His  facial  expression,  his  gait,  the 
color  of  his  skin  and  conjunctivas,  the  state  of  the  tongue, 
stomach,  and  bowels,  etc..  must  be  thoroughly  investigated. 
The  thermometer  will  show  the  body  temperature,  and  micro- 
scopic and  chemic  investigation  will  determine  the  condition 
of  the  blood  and  urinary  secretion,  thus  proving  or  disprov- 
ing the  existence  of  diabetes,  nephritis,  and  malaria,  each  of 
which  may  be  potent  factors  in  the  etiology. 

Microscope. — Aside  from  the  employrpent  of  the  micro- 
scope in  the  conditions  just  mentioned,  this  instrument  is  an 
invaluable  aid  in  dermatologic  practice.  With  it  the  char- 
acter of  tumors  may  be  determined  and  information  furnished 
as  to  the   nature  of  obscure  pathologic  processes.     It  is  of 


572  SPINAL  ADJUSTMENT 

especial  utility  in  recognizing  the  presence  of  fungi  or  of 
animal  parasites,  and  in  the  investigation  of  the  rapidly  ex- 
tending class  of  bacillary  diseases. 

Drug  and  Feigned  Eruptions. — The  ingestion  of  various 
drugs  produces  in  many  persons  diverse  lesions  of  the  skin, 
and  a  careful  inquiry  should  always  be  made  in  that  direction. 
The  same  observation  may  be  applied  in  regard  to  certain 
foods :  e.  g.,  urticarial  and  erythematous  rashes  are  often  due 
to  the  eating  of  strawberries  or  buckwheat,  and  eczemas  are 
sometimes  at  least  indirectly  connected  with  the  free  eating  of 
oatmeal.  Many  plants  set  up  severe  dermatitis,  and  heat  and 
cold  and  the  X-rays  are  also  responsible  for  similar  condi- 
tions. The  physician  should  also  be  fully  aware  that  feigned 
or  artificial  eruptions  are  not  infrequently  produced  upon 
themselves  by  hysterics  and  malingerers. 

Subjective  Symptoms. — The  merely  subjective  symptoms 
of  a  patient  are  not  of  paramount  importance  in  diagnosis ; 
still,  one  must  not  put  aside  as  of  no  importance  the  state- 
ments of  intelligent  persons  in  matters  relating  to  their  own 
experiences  of  pain,  itching,  burning,  or  other  sensations. 
Very  often  such  statements  may  be  verified  by  the  condition 
of  the  integument  itself;  for  example,  if  itching  is  severe,  the 
presence  of  scratch  marks  will  testify  to  its  existence."  (Gould 
and  Pyle.) 

Treatment. — The  treatment  of  skin  diseases  is  divided  into 
two  kinds,  the  internal  and  the  external.  The  first  requisite 
in  the  treatment  is  the  determination  of  the  exact  contributing 
cause  of  the  condition,  and  then  using  measures  directed 
toward  its  removal.  The  general  practitioner  is  usually  called 
upon  to  treat  such  skin  diseases  as  are  due  to  auto-intoxica- 
tion, disorders  of  digestion,  and  disturbances  of  metabolism. 
It  is  therefore  these  conditions  which  should,  in  all  cases,  be^ 
corrected.  The  first  essential  in  treating  skin  diseases  of  this 
kind,  is  spinal  adjustment.  In  all  cases  adjustments  of  the 
6th  and  10th  dorsal,  and  the  2nd  lumbar  vertebrae  should  be 
made;  in  addition  to  this,  adjustments  of  the  vertebrae  pro- 
ducing an  impingement  upon  the  nerve  governing  the  afifected 
part  of  the  body,  should  be  made.  Of  the  accessory  external 
methods  the  most  generally  useful  are  the  magnesium  sulphate 
baths,  and  magnesium  sulphate  compresses  to  the  local  area 


DISEASES  OF  THE  SKIN  5/3 

affected.  In  connection  with  this  the  hygiene  should  be  cor- 
rected, suitable  exercises  should  be  prescribed,  and  the  patient 
should  be  in  the  fresh  air  and  sun-light  as  much  as  possible. 
Internal  accessory  methods  consist  in  a  regulation  of  diet, 
attention  to  the  bowels,  and  the  internal  use  of  mineral  waters. 
Many  cases  of  skin  disease  require  the  care  of  a  specialist,  and 
consultation  with  a  dermatologist  is  advisable  in  most  in- 
stances. 


INDEX 


Abdncens,  nerve,  Tz  • 
Adams  position,  289 
Addison's  disease,  515 
Adjunct  measures,  whj^  used,  387 
Adjustment,  Spinal,  315 

and  adjunct  measures,  387 

of  cervical  vertebrae,  322 

of  dorsal  vertebrae,  341 

of  lumbar  vertebrae,  365 

practice  of,  383 
Alcoholism,  417 
Alimentary    tract,    tuberculosis    of, 

407 
Amblyopia,  531 
Amenorrhea,  540 
Amyotrophic  lateral  sclerosis,  496 
Analysis,  spinal,  279 
Anatomical  basis  of  chiropractic,  15 
Anchylostomiasis,  413 
Anemia,  512 

pernicious,  513 
Aneurysm,  454 
Angina  pectoris,  450 
Anteflexion,  540 
Anterior  subluxation,  271 

diagnostic  signs  of,  300 

holds  for  correction  of,  378.  379, 
381 
Anteversion,  541 
Aortic  plexus,  anatomy  of,  58 
Appendicitis,  472 
Arrythmia,  452 
Arsenic  poisoning,  419 
Arteriosclerosis,  453 
Arthritis  deformans,  422 
Ascariasis,  413 
Ascites,  483 
Asthma,  435 
Ataxia,  hereditary,  498 
Atlas,  palpation  of,  309 
Atrophy,  progressive  muscular,  496 
Auditory  nerve,  "JZ 
Automatism,  84 
Axis,  palpation  of,  309 

Bilateral  digito-transverse  hold,  358 
Bilateral    pisiform-transverse    hold, 

347.  365 
Bilious  fever,  410 


Bladder,  innervation  of,  157 

catarrh  of,  528 

tuberculosis  of,  408 
Blood  and  ductless  glands,  diseases 
of,  512 

Addison's  disease,  515 

Anemia,  512 
pernicious,   513 
chlorosis,  513 

Goiter,  516 

Leukemia,  514 

Myxedema,  517 

Pseudo-Leukemia,    515 
Bloody  flux,  400 
Bradicardia,  452 
Brain,  The,  62 

Anemia  of,  488 

Congestion  of,  487 

Diseases  of,   485 

Hemorrhage  of,  488 

Innervation  of,  117 
Bright's  disease,  acute,  520 

chronic,  521,  522 
Bronchial  tubes,  diseases  of,  433 
Bronchitis,  acute,  433 

chronic,  434 
Bronchopneumonia,  437 
Bulbar  paralysis,  495 

Caisson  disease,  500 
Calcaneo-pisiform-transverse   hold, 

353 

Calcaneo-spinous  hold,  359 

Cancrum  oris,  457 

Canker,  456 

Cardiac  plexus,  54 

Cataract,  532 

Catarrh,  acute  nasal,  429 
chronic  nasal,  430 

Causes  of  subluxations,  external,  179 
Age  as  a  cause  of,  185 
Exhaustion  as  a  cause  of,  186 
Habits  as  a  cause  of,  181 
Lijuries  as  a  cause  of,  181 
Occupation  as  a  cause  of,  180 

Causes  of  subluxation,  internal,  188 

Celiac  plexus.  The.  57 

Cerebral,  anemia,  488 

Cerebral  congestion,  487 


?/D 


576 


INDEX 


Cerebral  hemorrhage,  488 
Cerebro-spinal  nervous  system,  62 
Cerebrum,  diseases  of,  485 

innervation  of.  117 
Cerumen,  impacted,  536 
Cervical  vertebrae,  215 

adjustment  of,  322 

palpation  of,  309 
Chart,  spinal  analysis,  313 
Chemicals  and   drugs,   effect  of,  on 

nerves,  168 
Chicken-pox,  393 
Chloral  habit,  419 
Chlorosis,  513 
Cholelithiasis,  479 
Cholera  morbus,  469 
Chorea,  509 
Circulatory  system,  diseases  of,  442 

Aneurysm,  454 

Angina  pectoris,  450 

Arrythmia,   452 

Arteriosclerosis,  453 

Bradicardia,  452 

Cardiac  hypertrophy,  448 

Cardiac  dilatation,  449 

Endocarditis,  acute,  445 
chronic,   446 

Fatty  heart,  450 

Myocarditis,  acute,  444 
chronic,   443 

Palpitation  of  the  heart,  451 

Pericarditis,  acute,  442 
chronic,   443 

Tachycardia,  453 

Varicose  veins,  455 
Club-foot,  562 
Cocaine  habit,  418 
Colic,  intestinal,  471 
Colitis,  mucous,  472 
Compound  subluxations,  277 
Compression  subluxations,  265 

diagnostic  signs  of,  300 

holds  for  correction  of,  378,  379, 
381. 
Conduction  process,  The.  40 
Connection  between  sympathetic  and 

cerebro-spinal  nerves.  65 
Connection  between  sympathetic  sys- 
tem and  cranial  nerves,  67 
Constipation,  467 
Constitutional  diseases,  421 

Arthritis  deformans,  422 

Diabetes  insipidus,  427 

Diabetes  mellitus,  426 

Gout,  424 

Hemophilia,  426 

Obesity,  427 

Rheumatism,  chronic  articular,  421 
muscular,  421 

Rheumatoid  arthritis,  422 


Rickets,  424 

Scurvy,  425 
Consumption,  402 
Contact  points,  321 
Coryza,  429 
Cranial  nerves,  62,  67 

function  of,  90 

how  influenced  by  adjustment,  11 

abducens,  jt, 

auditory,  y2> 

facial,  72> 

glosso-pharyngeal,  J2> 

hypoglossal,  74 

motor  oculi,  72 

olfactory,  y2 

optic,  y2 

pneumogastric,  "Ji 

spinal  accessory,  74 

trigeminal,  7:^ 

trochlear,  72 
Cranial  and  spinal  reflexes,  190 
Cranial  reflexes,  190 
Crossed     bilateral     pisiform  -  trans- 
verse hold,  346 
Crossed  thumb-transverse  hold,  346 
Croup,  431 

Curves  of  the  spine,  216 
Cystitis,  528 

Deafness,  534 
Deformities,  562 

Club-foot,  562 

Flat-foot,  563 

Genu  valgum,  562 

Knock-knee,  562 

Talipes,  562 

Torticollis,  564 
Diabetes  insipidus,  427 
Diabetes  mellitus,  426 
Diagnosis,  spinal,  248 

in  abdominal  affections,  248 

value  of,  249 
Diaphragm,  innervation  of,  143 
Diarrhea,  468 

Diffusion  of  outgoing  impulses,  194 
Digestive  system,  diseases  of,  456 

Appendicitis,  472 

Ascites,  483 

Cancrum  oris,  457 

Canker,  456 

Cholera  morbus,  469 

Constipation,  467 

Diarrhea,  468 

Dropsy,  483 

Enteritis,  acute,  465 
chronic,    465 

Enteroptosis,  471 

Gall  stones,  479 

Gastric  carcinoma,  462 

Gastric  dilatation,  460 


INDEX 


577 


Gastric  neuroses,  463 
Gastric  ulcer,  461 
Gastritis,  acute,  458 

cliroiiic,  459 
Indigestion,   intestinal,   466 
Intestinal  colic,  471 

olistruction,  470 
Jaundice,  478 
Liver,  abscess  of,  476 

cancer   of,   477 

congestion   of,  473 

cysts  of,  476 

fatty,   474 

waxy,   475  _ 
Mucous  colitis,  472 
Pancreas,  cancer  of,  481 

cysts  of,  482 
Pancreatic  calculi,  482 
Pancreatitis,  acute,  480 

chronic,   481 
Peritonitis,  482 
Stomatitis,  aphthous,  456 

catarrhal,  456 

gangrenous,  457 

mercurial,    458 

parasitic,   458 

ulcerative,    457 
Yellow  atrophy,  acute,  478 
Diphtheria,  410 
Dorsal  position,  291 
Dropsy,  483 
Dysentery,  400 
Dysmenorrhea,  538 

Ear,  diseases  of,  533 

Ear-ache,  533 

Deafness,  534 

Impacted  cerumen,  526 

Innervation  of,  121 

Otitis  externa,  534 
media,    535 

Tinnitus  aurium,  533 

Vertigo,  535 
Effects    of    vertebral    subluxations, 
local,  199 

on  afferent   spinal   nerve,   2co 

on  arteries,  201 

on  circulation,  2og 

on  cranial  nerve  functions,  211 

on  efferent  spinal  nerve,  200 

on  existing  action,  207 

on  gray  rami  communicantes,  20 1 

on  lymphatics,  202 

on  metabolism,  208 

on  movement  and  sensibility,  203 

on  nutrition,  205 

on  organs,  209 

on  reflex  action,  210 

on  resistance,  203 

on  secretion  and  excretion,  206 


on  temperature,  207 

on  veins,  202 

on  white      rami      communicantes, 
200 
Efferent  action  of  nerves,  56 
Eighth     cervical     nerve,     parts     in- 
fluenced by,  253 
Eighth     thoracic     nerve,     parts     in- 
fluenced by,  253 
Eleventh    thoracic    nerve,    parts    in- 
fluenced by,  254 
Endocarditis,  acute,  445 

chronic,  446 
Endometritis,  acute,  544 

chronic,  544 
Enteritis,  acute,  465 

chronic,  465 
Enteroptosis,  471 
Enuresis,  530 
Epilepsy,  504 
Erect  position,  291 
Erysipelas,  399  , 

Etiology  of  disease,  8 
Exit  of  spinal  nerves  in  respect  to 

spines,  223 
Extremes  of  temperature  on  nerves. 

167 
Eye,  diseases  of,  531 

amblyopia,  531 

cataract,  532 

lachrymation,  531 

mydriasis  and  myosis,  532 

optic  neuritis,  533 

ptosis,  532 

retinitis,  533 

squint,  531 

strabismus,  531 
Eye,  innervation  of,  119 

Facial  nerve,  'j^i 

Fallopian  tubes,  innervation  of,   157 

Tuberculosis  of,  408 
Fatigue  of  nerves,  165 
Fifth  cervical  nerve,  parts  influence  1 

by,  251 
Fifth  lumbar  nerve,  parts  influenced 

by,  254 
Fifth  thoracic  nerve,  parts  influenced 

by,  253 
Filariasis,  414 
First  cervical  nerve,  parts  influenced 

by.  251 
First  lumbar  nerve,  parts  influenced 

by,  254 
First  sacral  nerve,  parts  influenced 

by,  254 
First  thoracic  nerve,  parts  influenced 

by,  253 
Fourth     cervical     nerve,     parts     in- 
fluenced by,  251 


578 


INDEX 


Fourth  lumbar  nerve,  parts  in- 
fluenced by,  254 

Fourth  sacral  nerve,  parts  influenced 
by,  255 

Fourth  thoracic  nerve,  parts  in- 
fluenced by,  253 

Flat-foot,  563 

Food  poisons,  420  . 

Friedreich's  disease,  498 

Fronto-transverse  hold,  328 

Gall  stones,  479 
Gangliated  cords.  The,  10 
Gastric  plexus.  The,  57 
Gastritis,  acute,  458 

chronic,  459 
Genito-urinary   system,   diseases   of, 

519 

Cystitis,  528 

Enuresis,    530 

Floating  kidney,  525 

Hydronephrosis,  526 

Kidneys,  congestion  of,  519 

Movable  kidney,  525 

Nephritis,   acute  parenchymatous, 
520 

chronic    interstitial,   522 
chronic   parenchymatous,   521 

Nephrolithiasis,  526 

Prostate,  hypertrophy  of,  529 

Pyelitis,  527 

Uremia,  524 

Waxy  kidney,  524 
Genito-urinary  tract,  tuberculosis  of, 

407 
Genu-deltoid  hold,  zil 
Genu-spinous  hold,  371 
Genu  valgum,  562 
German  measles,  396 
Glosso-pharyngeal  nerve,  T>i 
Goitre,  516 

exophthalmic,  516 
Gout,  424 

Gray  rami  communicantes,  64 
Gynecological  diseases,  537 

Amenorrhea,  540 

Anteflexion,  540 

Anteversion,  540 

Dysmenorrhea,  538 

Endometritis,  acute,  544 
chronic,   544 

Leucorrhea,  540 

Menorrhagia     and     metrorrhagia, 
539 

Metritis,  acute,  545 
chronic,   546 

Oophoritis,  acute,  548 
chronic,   548 

Ovaries,  congestion  of,  547 

Peritonitis,  pelvic,  549 


Prolapsus  uteri,  543 
Pruritus  vulvae,  537 
Retroflexion,  542 
Salpingitis,  547 
Vaginitis,  537 
Vulvitis,  537 

Hay  fever,  434 
Headache,  489 
Hearing,  82 
Heart,  fatty,  450 
Heart,  diseases  of,  442 

Dilatation  of,  449 

Hypertrophy  of,  448 

Palpitation  of,  451 

Valvular  disease  of,  446 
Heart,  innervation  of,  135 
Hemophilia,  426 
Hepatic  plexus,  57 
Hereditary  ataxia,  498 
Hodgkin's  disease,  515 
Holds 

Bilateral  digito-transverse,  358 

Bilateral  pisiform-transverse,  347, 
365 

Calcaneo-pisiform-transverse,  353 

Calcaneo-spinous,  359 

Crossed    bilateral    pisiform-trans- 
verse, 346 

Crossed  thumb-transverse,  346 

Fronto-transverse,  328 

Genu-deltoid,  ZT] 

Genu-spinous,  371 

Ilio-deltoid,  371 

Ilio-spinous,  365 

Infra-iliac,  370 

Malar-transverse,  329 

Mandibulo-spinous,  359 

Occipito-mandibular  A,  335 

Occipito-mandibular  B,  335 

Occipito-mandibular  C,  335 

Pisiform-spinous,  352,  370 

Pisiform-transverse,  328 

Recoil,  The,  364 

Sacro-spinous,  363 

Supra-iliac,  370 

Supra-sacral,  370 

Temporo-centrum,  334 

T.   M.  or  thumb  movement,  329, 

Temporo-occipital,  340 
Temporo-transverse,  322 
Thumb-transverse,  341,  365 
Thoracic  extension  I,  363 
Thoracic  extension  H,  364 
Ulno-spinous,  353,  365 
Unilateral  pisiform-transverse, 

353,  370 
Unilateral  pisiform-transverse, 

anterior,  329 


INDEX 


579 


Hydronephrosis,  526 
Hydrothorax,  441 
Hypogastric  plexus,  59 
Hypoglossal  nerve,  74 
Hysteria,  505 

Ilio-deltoid  hold,  271 
Ilio-spinous  hold,  365 
Indigestion,  intestinal,  466 
Infantile  paralysis,  490 
Infectious  diseases,  390 

Bloody  flux,  400 

Chicken-pox,  393 

Diphtheria,  410 

Dysentery,  400 

Erysipelas,  399 

German  measles,  396 

Influenza,  398 

Intermittent  fever,  409 

Lagrippe,  398 

Malaria,  409 

Measles,  395 

Mumps,  396 

Parotitis,  epidemic,  396 

Pellagra,  412 

Pertussis,  397 

Relapsing  fever,  408 

Remittent  fever,  410 

Rheumatism,  acute  articular,  399 

Rubella,  396 

Scarlet  fever,  394 

Small-pox,  392 

Tuberculosis,  401 

Typhoid  fever,  390 

Varicella,  393 

Whooping  cough,  397 
Inferior  cervical  ganglion,  51 
Inferior  hemorrhoidal  plexus,  59 
Influenza,  398 
Infra-iliac  hold,  370 
Inhibition  and  augmentation,  85,  8' 
Innervation,  iii 

of  bladder,  157 

of  brain,  117 

of  diaphragm,  143 

of  ear,  121 

of  eye,  119 

of  face  and  neck,  115 

of  heart,  135 

of  kidneys,  153 

of  large  intestine,  149 

of  larynx,  127 

of  liver,  145 

of  lungs,  139 

of  mammary  gland,  135 

of  nose,   123 

of  organs  of  abdomen,  143 

of  organs  of  pelvis,  157 

of  organs  of  thorax,  135 

of  ovaries,  159 


of  pancreas,  145 

of  penis,  161 

of  peritoneum,  143 

of  pharynx,  125 

of  prostate  gland,  159 

of  scalp,  113 

of  small  intestine,  151 

of  spleen,  145 

of  stomach,  147 

of  structures  of  cranium,  face  and 
neck.  III 

of  suprarenal  capsules,  155 

of  teeth  and  oral  cavity,  131 

of  testicles,  161 

of  thyroid  gland,  131 

of  tongue,  129 

of  tonsils,  127 

of  uterus,  157 

of  vagina,  161 
Intermittent  fever,  409 
Intervertebral  discs,  function  of,  21 
Intervertebral    foramen,   boundaries 
of.  5 

calibre  of,  6 

contents  of,  12 

measurements  of,  12 
Intoxications,  The,  417 

Alcoholism,  417 

Arsenic  poisoning,  419 

Chloral  habit,  419 

Cocaine  habit,  418 

Food  poisons,  420 

Lead  poisoning,  419 

Morphine  habit,  418 
Intestines,  diseases  of,  465 

innervation  of,  149,  151 
Irritability  of  nerves,  41 

Jaundicf,  478 

Joints,  diseases  of,  564 

Kidneys,  congestion  of,  519 

floating,  525 

innervation  of,  153 

waxy,  524 
Knock-knee,  562 
Kyphosis,  553 
Kyphotic  subluxation,  260 

diagnostic  signs  of,  302 

holds  for  correction  of,  378,  379, 
382 

Lachrymation,  531 
La  Grippe,  398 
Laryngitis,  acute,  430 

chronic,  430 

edematous,  431 

spasmodic,  431 
Larynx,  diseases  of,  430 

innervation  of,   127 

tuberculosis  of,  407 


580 


INDEX 


Lateral  subluxation,  269 

diagnostic  signs  of,  301 

holds  for  correction  of,  378,  379, 
380 
Lead  poisoning,  419 
Leucorrhea,  540 
Leukemia,  514 
Ligaments  of  the  spinal  column,   16 

reflex  influence  upon,  17 
Liver,  diseases  of,  473 

Abscess  of,  476 

Cancer  of,  477 

Congestion  of,  473 

Cysts  of,  476 

Fatty,  474 

Linervation  of,  145 

Waxy,  475 
Local  effects  of  vertebral   subluxa- 
tions, 199 

on  afferent  spinal  nerve,  200 

on  arteries,   201 

on  efferent  spinal  nerve.  200 

on  gray  rami  communicantes,  201 

on  lymphatics,  202 

on  veins,  202 

on  white  rami  communicantes,  200 
Locomotor  ataxia,  492 
Lordosis,  554 
Lordotic  subluxation.  262 

diagnostic  signs  of,  302 

holds  for  correction  of,  378,  379, 
382 
Lumbar  portion  of  gangliated  cord, 

53 
Lumbar  vertebrae,  216 

palpation  of,  313 
Lungs,  diseases  of,  435 

congestion  of,  435 

edema  of,  436 

hemorrhage  of,  436 

innervation  of,  139 

tuberculosis  of,  401 

Malalignment  of  vertebrae,  163.  171 
as    a    sign    of    vertebral    subluxa- 
tions, 240 

?^Ialaria,  409 

Malar-transverse  hold,  329 

Malnutrition   of  nerves,    166 

Mammary     gland,     innervation     of, 
135 

Mandibulo-spinous  hold,  359 

Measles.   395 

Mechanical  conditions,  influence  of, 
on  nerves.   169 

Meningitis,  485 

Menorrhagia  and  metrorrhagia,  539 

Mental  diseases,  511 

Metritis,  acute,  545 
chronic,  546 


Middle  cervical  ganglion,  51 
^lorphine  habit,  418 
Motor  function  of  nerves,  86 
Motor  oculi  nerve,  72 
Mouth,  diseases  of,  456 

innervation  of,  131 
Movements  of  the  spine,  217 
Mucous  colitis,  472 
Mumps,  396 
Muscular  sense,  80 
Mydriasis   and   myosis,   532 
Myelitis,  acute,  494 
Myocarditis,  acute,  444 

chronic,  443 
Myxedema,  517 

Nasal  catarrh,  acute,  429 

chronic,  430 
Nephritis,  acute  parenchymatous,  520 

chronic  interstitial,  522 

chronic  parenchymatous,  521 
Nephrolithiasis,  526 
Nerve  function,  abnormal,  163 

causes  of,  164 
Nerve-impulse,  40 

origin  of,  75 
Nerves,  effect  of  blood-supply  upon, 

43 
effect  of  lymphatics  upon,  44 
effect  of  pressure  upon,  42 
function  of,  39,  75,  86 
irritability  of,  41 
Nervous  system,  diseases  of.  485 
Amyotrophic  lateral  sclerosis,  456 
Bulbar  paralysis,  495 
Caisson  disease,  500 
Cerebral  anemia,  488 

congestion,   487 

hemorrhage,  488 
Chorea.   509 
Epilepsy,  504 
Facial  paralysis,  503 
Headache,  489 
Hysteria,  505 
Locomotor  ataxia,  492 
Meningitis,  485 
Mental  diseases,  511 
IMultiple  sclerosis,  498 
Myelitis,  acute,  494 
Neuralgia,  502 
Neurasthenia,  508 
Neuritis,  multiple,  501 

simple,  500 
Occupation  neuroses,  511 
Paralysis  agitans,  510 
Paraplegia,  ataxic.  497 
Poliomyelitis,   acute   anterior,  490 
Progressive  muscular  atrophy,  496 
Syringomyelia,   499 
Tabes  dorsalis,  492 


INDEX 


581 


Tetany,  510 

Wasting  palsy,  496 
Neuralgia,  502 
Neurasthenia,  508 
Neuritis,  multiple,  501 

optic,  533 

simple,  500 
Ninth     thoracic     nerve,     parts     in- 
fluenced by,  253 
Nose,  diseases  of,  429 

innervation  of,  123 

Obesity,  427 

Obstruction,  intestinal,  470 
Occipito-mandibular  hold  A,  335 
Occipito-mandibular  hold  B,  335 
Occipito-mandibular  hold  C,  335 
Occupation  neuroses,  511 
Olfactory  nerve,  72 
Oophoritis,  acute,  548 

chronic,  548 
Opposition     to     theory     of     chiro- 
practic, 15 
Optic  nerve,  72 
Optic  neuritis,  533 
Origin  of  chiropractic,  i 
Osteopathy  and  chiropractic,  3 
Otitis  externa,  534 

media,  535 
Outgoing  impulses,  diffusion  of,  194 
Ovaries,  congestion  of,  547 

innervation  of,  159 

Pain  as  a  symptom  of  subluxation, 
13,  243 

sense  of,  80 
Palpation  of  various  vertebrae,  303 
Pancreas,  cancer  of,  481 

cysts  of,  482 

diseases  of,  480 

innervation  of,  145 
Pancreatic  calculi,  482 
Pancreatitis,  acute,  480 

chronic,  481 
Paralysis  agitans,  510 

facial,  503 
Paraplegia,  ataxic,  497 
Parasitic  diseases,  413 

Anchylostomiasis,    413 

Ascariasis,  413 

F'ilariasis,  414 

Tapeworms,  415 

Trichinosis,  416 
Parotitis,  epidemic,  396 
Pellagra,  412 
Pelvic  plexus,  59 

portion  of  gangliated  cord.  53 
Pericarditis,  acute,  442 

chronic,  443 


Peritoneum,  diseases  of,  482 

innervation  of,  143 
Peritonitis,  acute  general,  482 
Peritonitis,  pelvic,  549 
Pertussis,  397 

Pharynx,  innervation  of,  125 
Phrenic  plexus,  56 
Phthisis,  402,  404 

chronic,  404 

fibroid,  405 

pneumonic,  402 
Physiological  basis  of   chiropractic, 

39 
Pisiform-spinous  hold,  352,  370 
Pisiform-transverse  hold,  328 
Pleura,  diseases  of,  438 
Pleurisy,  438 
Pneumogastric  nerve,  "JZ 
Pneumonia,  lobar,  437 
Pneumothorax,  440 
Poise   as   a   requisite   to   the  thrust, 

317 
Poliomyelitis,  acute  anterior,  490 
Position  of  the  patient,  289 

of  the  vertebrae,  219 
Positions 

Adams,  289 

dorsal,  291 

erect,  291 

prone,  291 
Posterior  subluxation,  273 

diagnostic  signs  of,  300 

holds   for  correction  of,  378,  379, 
381 
Prolapsus  uteri,  543 
Prone  position.  291 
Prostate  gland,  hypertrophy  of,  529 

innervation  of,  159 

tuberculosis  of,  408 
Prostatic  plexus,  59 
Pruritus  vulvae,  537 
Pseudo-leukemia,  515 
Ptosis,  532 
Pyelitis,  527 

Recoil,  The,  364 
Reflex  act.  The,  191 
Reflex  action,  83 
Reflex  cycle.  188 

Reflex  production  of  vertebral  sub- 
luxations, 195 
Reflexes,  cranial.  IQC 

cranial  and  spinal,  190 

spinal,   189 

spinal  and  cranial,   190 
Regional  classification  of  holds,  37S 
Relapsing  fever,  408 
Remittent  fever,  410 
Renal  plexus,  57 


582 


INDEX 


Respiratory  system,  diseases  of,  429 
Asthma,  435 
Bronchitis,  acute,  433 

chronic,    434 
Bronchopneumonia,  437 
Hay  fever,  434 
Hydrothorax,  441 
Laryngitis,  acute,  430 
chronic,  430 
edematous,  431 
spasmodic,  431 
Lobar  pneumonia,  437 
Nasal  catarrh,  acute,  429 

chronic,  430 
Pleurisy,  438 
Pneumothorax,  440 
Pulmonary  congestion,  435 
edema,  436 
hemorrhage,  436 
Tonsillitis,  432 
Retinitis,  533 

Retroflexion   of  uterus,  542 
Rheumatism,  acute  articular,  399 
chronic  articular,  421 
muscular,  421 
Rheumatoid  arthritis,  422 

spondylitis,    561 
Rickets,  424 
Round  shoulders,  554 
Rotary  subluxation,  274 
diagnostic  signs  of,  301 
holds  for  correction  of,  378,  379, 
380 
Rubella,  396 

Sacro-spinous  hold,  363 
Salpingitis,  547 
Scarlet  Fever,  394 
Sclerosis,  multiple,  498 
Scoliosis,  551 
Scoliotic  subluxation,  264 
diagnostic  signs  of,  302 
holds  for  correction  of,  378,  379, 
382 
Second    cervical    nerve,    parts    in- 
fluenced by,  251 
Second     lumbar    nerve,     parts     in- 
fluenced by,  254 
Second  sacral  nerve,  parts  influenced 

by,  255 
Second    thoracic    nerve,    parts    in- 
fluenced by,  253 
Secretory  function  of  nerves,  88 
Segmental  localization,  225 
Sensations,  Ti 
common,  78 
subjective,  80 
Seventh    cervical    nerve,    parts    in- 
fluenced by,  253  ' 


Seventh    thoracic    nerve,    parts    in- 
fluenced by,  253 
Sight,  82 
Signs  of  vertebral  subluxations,  239, 

279 
Sixth  cervical  nerve,  parts  influenced 

by,  251 
Sixth  thoracic  nerve,  parts  influenced 

by,  253 
Skin,  diseases  of,  565 
Small-pox,  392 
Smell,  sense  of,  82 
Solar  plexus,  55 
Spermatic  plexus,  57 
Spinal  accessory  nerve,  74 
Spinal  adjustment,   general  consid- 
erations of,  315 

practice  of,  383 
Spinal  analysis,  279 
Spinal    analysis    chart,    method    of 

using,  313 
Spinal  and  cranial  reflexes,  190 

diseases  of,  490 
Spinal  cord,  62 
Spinal  nerve,  9,  62 

anterior  root  of,  63 

attachment  of  to  cord,  221 

exit    of    in    respect    to    spinous 
processes,  223 

posterior  root  of,  63 
Spinal  reflexes,  189 
Spinal  segments,  225 
Spinal   symptomatology,  239 
Spine,  The,  213 

dislocations  of,  556 

fracture  of,  558 

injuries  and  diseases  of,  551 

kyphosis,  551 

lordosis,  554 

movements  of,  217 

normal  curves  of,  216 

osteoarthritis   of,    561 

osteomyelitis  of,  561 

rheumatoid   spondylitis,   561 

round   shoulders,   554 

scoliosis,  551 

spondylolisthesis,  5=^:1 

sprains  of,  555 

syphilitic  disease  of,  560 

tuberculosis  of,  559 
Spinous  process,  palpation  of,  285 
Splenic  plexus,  58 
Spondylolisthesis,  554 
Spontaneity   as    a    requisite    to    the 

thrust,  317 
Spontaneous  adjustment,  175  - 
Spleen,  innervation  of,  145 
Squint,  531 
Stomach,  cancer  of,  462 

dilatation  of,  460 


INDEX 


583 


diseases  of,  485 
innervation  of,  147 
neuroses  of,  463 
ulcer  of,  461 
Stomatitis,  aphthous,  456 
catarrhal,  456 
gangrenous,  457 
mercurial,  458 
parasitic,  458 
ulcerative,  457 
Strabismus,  531 
Stye,   532 

Subluxations,  vertebral,  163,  171 
anatomical  changes  as  a  sign  of, 

247,.  284 
and  disease,  383 
anterior,  271 
caused  of ,  external,  179 

age,  185 

exhaustion,  186 

habits,   181 

injuries,  181 

occupation,  180 
causes  of,  internal,  188 
compound,  277 
compression,  265 
contraction  of  ligaments  of  spine 

as  a  sign  of,  241,  282 
demonstration  of,  on  cadaver,  27 
diagnosis  of,  293 
diagnostic  signs  of  each  form  of, 

300 
diminished  mobility  of  back  as  a 

sign  of,  242,  283 
effect  of,  on  circulation,  209 

on  cranial  nerve   functions,  211 

on  existing   action,   207 

on  metabolism,  208 

on  movement     and     sensibility, 
203 

on  nerve  function,  203 

on  nutrition,  205 

on  organs,  209 

on  reflex  action,  210 

on  resistance,  203 

on  secretion  and  excretion,  206 

on  temperature,  207 
forms  of,  260 
functional  disturbances  as  a  sign 

of,  244,  281 
inspection  in  the  diagnosis  of,  293 
kyphotic,  260 
lateral,   269 
local  effects  of,  199 

on  afferent  spinal  nerve,  200 

on  arteries,  201 

on  efferent  spinal  nerve,  200 

on  gray    rami    communicantes, 
201 


on  lymphatics,  202 
on  veins,  202 

on  white    rami    communicantes, 
200 

local  zone  of  increased  tempera- 
ture as  a  sign  of,  246 

lordotic,  262 

malalignment    of   vertebrae    as    a 
sign  of,  240,  285 

nature  of,  173 

pain  as  a  symptom  of,  243,  280 

palpation  in  the  diagnosis  of,  295 

posterior,  273 

physical  explanation  of,  258 

production  of,  18 

vertical  posture  in,  22 

reflex  production  of,  195 

region  of  spine  where  found,  276, 

rotary,  274 

scoliotic,  264 

results  of,  general,  175 

supero-inferior,  267 

temperature  variations  as  a  sign 

of,  281 
tenderness  as  a  symptom  of,  244. 

280 
thickening  of   nerve   trunks   as   a 
sign  of,  247,  280 
Sunstroke,  420 
Superior   cervical   ganglion,    n,   49, 

68 
Superior  mesenteric  plexus,  58 
Supero-inferior  subluxation,  267 
diagnostic  signs  of,  301 
holds  for  correction  of,  378,   379, 
380 
Suprarenal  capsules,  innervation  of, 

155 
Suprarenal  plexus,  57 
Supra-iliac  hold,  370 
Supra-sacral  hold,  370 
Sympathetic   nervous   system,   anat- 
omy of,  10,  47 
physiology  of,  93 
influence  on  circulation,   loi 
on  excretion,    104 
on  heat  production,  97 
on  metabolism,    100 
on  movement     and     sensibility, 

94 
on  nutrition,  95 
on  other  existing  action,   106 
on  organs,    109 
on  reflex  actions,  108 
on  secretional,   103 
on  special  senses,  106 
Symptomatology,   spinal,  239 
Syringomyelia,  497 


584 


INDEX 


Tabes  dorsalis,  492 

Tachycardia,  453 

Talipes,  562 

Tapeworms,  415 

Taste,  sense  of,  81 

Teeth,  innervation  of,  131 

Temperature   sense,   79 

Temporo-centrum  hold,  334 

Temporo-occipital  hold,  340 

Temporo-transverse   hold,   322 

Tenderness  as  a   symptom  of   sub- 
luxation, 244 

Tenth    thoracic    nerve,    parts    influ- 
enced by,  254 

Testes,  innervation  of,   161 
tuberculosis  of,  408 

Tetany,  510 

Theoretical  basis  of  chiropractic,  5 

Third    cervical    nerve,    parts    influ- 
enced by,  251 

Third    lumbar    nerve,    parts    influ- 
enced by,  254 

Third  sacral  nerve,  parts  influenced 
.  by,  255 

Third    thoracic    nerve,    parts    influ- 
enced by,  253 

Thoracic  extension  hold  I,  363 

Thoracic  extension  hold  II,  364 

Thoracic  portion  of  gangliated  cord. 

52  . 
Thoracic  vertebrae,  215 

palpation  of,  311 
Thrust,    proper    application    of    the, 
316 

mode  of  delivery,  319 
Thumb-transverse  hold,  341,  365 
Thyroid   gland,   innervation  of,   131 
Tinnitus  aurium,  533 
T.  M.  hold,  329,  358 
Tongue,  innervation  of,  129 
Tonsillitis,  432 
Tonsils,  innervation  of,  127 
Torticollis,  564 
Touch,  sense  of,  79 
Transverse  processes,  malalignment 
of,  285 

palpation  of,  287 
Traumatism  of  nerves,   167 
Trichinosis,   416 
Trigeminal  nerve,  jz 


Trochlear  nerve,  ^2 

Trophic  function  of  nerves,  88 

Tuberculosis,  401 

acute  miliary,  402 

of  alimentary  tract,  407 

of  Fallopian  tubes,  408 

of  genito-urinary  tract,  407 

of   larynx,  407 

of  prostate  gland,  408 

of  testes,  408 

of  ureter  and  bladder,  408 

pulmonary,  402.  404 

treatment  of,  406 
Twelfth  thoracic  nerve,  parts  influ- 
enced by,  254 
Typhoid  fever,  390 

Ulno-spinous  hold,  353,  365 
Unilateral    pisiform-transverse    an- 
terior hold,  329 
Unilateral  pisiform-transverse  hold, 

353,  370 
Uremia,  524 
Ureter,  innervation  of,   153 

tuberculosis  of,  408 
Uterus,   diseases   of,   538 

innervation  of,    157 

prolapse  of,  543 

Vagina,  innervation  of,  161 
Vaginal  plexus,  60 
Vaginitis,   537 
Varicella,  393 
Varicose  veins,  455 
Vertebrae,  cervical,  215 

lumbar,   216 

palpation  of,  303 

position  of,  219 

thoracic,  215 
Vertebral  column,  213 

normal  curves  of,  216 

normal  movements  of,  217 
Vertigo,  535 
Vesical  plexus,  59 
Vulvitis,  537 

White  rami  communicantes,  64 
Whooping  cough,  397 

Yellow  atrophy,  acute,  478 


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